Healthcare Provider Details

I. General information

NPI: 1598683591
Provider Name (Legal Business Name): MEDORYX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 W 5TH ST
SHERIDAN WY
82801-2707
US

IV. Provider business mailing address

30 N GOULD ST # 62171
SHERIDAN WY
82801-6317
US

V. Phone/Fax

Practice location:
  • Phone: 213-772-0369
  • Fax:
Mailing address:
  • Phone: 213-772-0369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: VICTOR BANKS
Title or Position: MANAGER
Credential:
Phone: 213-772-0369