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General NPI Number Information
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NPI Number | 1144580382
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Entity Type | Organization
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Legal Business Name | MED X CHANGE, LLC
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 325 S 5TH ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2630
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Country | US
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Telephone | 636-949-5660
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Fax | 636-949-5665
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Provider Business Mailing Address
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Address Line | 325 S 5TH ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2630
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Country | US
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Telephone | 636-949-5660
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Fax | 636-949-5665
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Authorized Official
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Title or Position | PHYSICAL THERAPY ASSISTANT
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Name | MR. CHRIS MAYES
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Credential | P.T.A.
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Telephone | 636-949-5660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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