Healthcare Provider Details

I. General information

NPI: 1801470612
Provider Name (Legal Business Name): SONORAN MEDICAL SUPPLIES, LLC DBA MADDOX MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N ARIZONA BLVD
COOLIDGE AZ
85128-3727
US

IV. Provider business mailing address

1044 N ARIZONA BLVD
COOLIDGE AZ
85128-3727
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-8871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: GUS PANTELIDES
Title or Position: OWNER
Credential:
Phone: 480-256-8871