Healthcare Provider Details

I. General information

NPI: 1790528081
Provider Name (Legal Business Name): MEDRAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W GALVESTON ST STE 4
CHANDLER AZ
85225-6714
US

IV. Provider business mailing address

30 W GALVESTON ST STE 4
CHANDLER AZ
85225-6714
US

V. Phone/Fax

Practice location:
  • Phone: 480-550-8566
  • Fax: 480-372-3067
Mailing address:
  • Phone: 480-550-5866
  • Fax: 480-372-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RIZWAN SOHAIL
Title or Position: CEO
Credential:
Phone: 480-550-8566