Provider Demographics
NPI:1013913169
Name:MEDICAL XPRESS OF SW FL INC
Entity Type:Organization
Organization Name:MEDICAL XPRESS OF SW FL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-590-0167
Mailing Address - Street 1:15600 SAN CARLOS BLVD
Mailing Address - Street 2:STE 13
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2564
Mailing Address - Country:US
Mailing Address - Phone:239-590-0167
Mailing Address - Fax:239-590-0107
Practice Address - Street 1:15600 SAN CARLOS BLVD
Practice Address - Street 2:STE 13
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2564
Practice Address - Country:US
Practice Address - Phone:239-590-0167
Practice Address - Fax:239-590-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312191332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5053810001Medicare ID - Type UnspecifiedPROVIDER ID