=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144130642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDFREBS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2026
-----------------------------------------------------
Last Update Date | 09/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7800 66TH ST N STE 202
-----------------------------------------------------
City | PINELLAS PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33781-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-477-2988
-----------------------------------------------------
Fax | 727-516-4788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7800 66TH ST N STE 202
-----------------------------------------------------
City | PINELLAS PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33781-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-477-2988
-----------------------------------------------------
Fax | 727-516-4788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HR
-----------------------------------------------------
Name | CHARLES E ARCHIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-850-0614
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------