Healthcare Provider Details

I. General information

NPI: 1033460696
Provider Name (Legal Business Name): MEDTIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S REHOBOTH BLVD
MILFORD DE
19963-1568
US

IV. Provider business mailing address

16337 COASTAL HWY
LEWES DE
19958-3607
US

V. Phone/Fax

Practice location:
  • Phone: 302-265-4550
  • Fax:
Mailing address:
  • Phone: 302-645-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2012605626
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number2012605626
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number2012605626
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number2012605626
License Number StateDE

VIII. Authorized Official

Name: MR. JACK BERBERIAN
Title or Position: MEMBER
Credential:
Phone: 302-645-8070