MEDICARE: MATRIX MED INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1508840729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRIX MED INC

Provider Business Mailing Address
First Line	:	11240 WAPLES MILL RD
Second Line	:	STE 307
City	:	FAIRFAX
State	:	VA
Zip	:	22030-6078
Country	:	US
Telephone Number	:	703-563-0044
Fax Number	:	703-563-0028

Provider Business Practice Location Address
First Line	:	11240 WAPLES MILL RD
Second Line	:	STE 307
City	:	FAIRFAX
State	:	VA
Zip	:	22030-6078
Country	:	US
Telephone Number	:	703-563-0044
Fax Number	:	703-563-0028

Authorized Official
Title or Position	:	CEO
Name	:	MR. EHAB SHAFIK
Credential	:
Telephone Number	:	703-563-0044

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	01/23/2009

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