Provider Demographics
NPI:1508840729
Name:MATRIX MED INC
Entity Type:Organization
Organization Name:MATRIX MED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-563-0044
Mailing Address - Street 1:11240 WAPLES MILL RD
Mailing Address - Street 2:STE 307
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6078
Mailing Address - Country:US
Mailing Address - Phone:703-563-0044
Mailing Address - Fax:703-563-0028
Practice Address - Street 1:11240 WAPLES MILL RD
Practice Address - Street 2:STE 307
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6078
Practice Address - Country:US
Practice Address - Phone:703-563-0044
Practice Address - Fax:703-563-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5462570001Medicare NSC