Healthcare Provider Details

I. General information

NPI: 1255836250
Provider Name (Legal Business Name): MED-X HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 DELAWARE AVE STE 101
BUFFALO NY
14202-1009
US

IV. Provider business mailing address

625 DELAWARE AVE STE 101
BUFFALO NY
14202-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-777-4372
  • Fax:
Mailing address:
  • Phone: 716-777-4372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DOLE
Title or Position: PRESIDENT
Credential:
Phone: 716-777-4372