Provider Demographics
NPI:1972044477
Name:RX MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:RX MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAURENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-444-3470
Mailing Address - Street 1:1230 S MISSOURI AVE
Mailing Address - Street 2:703
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-9174
Mailing Address - Country:US
Mailing Address - Phone:954-444-3470
Mailing Address - Fax:
Practice Address - Street 1:1230 S MISSOURI AVE
Practice Address - Street 2:703
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-9174
Practice Address - Country:US
Practice Address - Phone:954-444-3470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies