Provider Demographics
NPI:1891081493
Name:MEDAX MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:MEDAX MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-635-7644
Mailing Address - Street 1:8938 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5163
Mailing Address - Country:US
Mailing Address - Phone:847-635-7644
Mailing Address - Fax:847-635-7670
Practice Address - Street 1:8938 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5163
Practice Address - Country:US
Practice Address - Phone:773-465-0040
Practice Address - Fax:773-465-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies