Healthcare Provider Details

I. General information

NPI: 1043464811
Provider Name (Legal Business Name): MEDX ACQUISITION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 GREAT VALLEY PKWY
MALVERN PA
19355-1308
US

IV. Provider business mailing address

279 GREAT VALLEY PKWY
MALVERN PA
19355-1308
US

V. Phone/Fax

Practice location:
  • Phone: 610-971-1900
  • Fax: 610-971-2200
Mailing address:
  • Phone: 610-971-1900
  • Fax: 610-971-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH W DESTEFANO
Title or Position: PRESIDENT & CEO
Credential:
Phone: 610-971-1900