Provider Demographics
NPI:1750038717
Name:MEDEX, LLC
Entity Type:Organization
Organization Name:MEDEX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:303-591-5767
Mailing Address - Street 1:MEDEX, LLC
Mailing Address - Street 2:98 WADSWORTH BLVD, UNIT 127-7122
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1553
Mailing Address - Country:US
Mailing Address - Phone:303-591-5767
Mailing Address - Fax:
Practice Address - Street 1:MEDEX, LLC
Practice Address - Street 2:98 WADSWORTH BLVD, UNIT 127-7122
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1553
Practice Address - Country:US
Practice Address - Phone:303-591-5767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09129227Medicaid