Provider Demographics
NPI:1487651378
Name:MEDEX, LLC
Entity Type:Organization
Organization Name:MEDEX, LLC
Other - Org Name:MEDICAL EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SYREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-883-1850
Mailing Address - Street 1:975 JAYMOR RD STE 6
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3854
Mailing Address - Country:US
Mailing Address - Phone:215-942-9800
Mailing Address - Fax:215-942-7711
Practice Address - Street 1:975 JAYMOR RD STE 6
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3854
Practice Address - Country:US
Practice Address - Phone:215-942-9800
Practice Address - Fax:215-942-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1000002645332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017452390003Medicaid
PA002815OtherINDEPENDENCE BLUE CROSS
PA002815OtherINDEPENDENCE BLUE CROSS