Healthcare Provider Details

I. General information

NPI: 1740177328
Provider Name (Legal Business Name): MED WAY MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5929 FASHION POINT DR STE 103
SOUTH OGDEN UT
84403-4683
US

IV. Provider business mailing address

555 E NORTH LN STE 5075
CONSHOHOCKEN PA
19428-2233
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-0567
  • 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: WENDY RUSSALESI
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 484-246-9499