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General NPI Number Information
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NPI Number | 1871591974
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Entity Type | Organization
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Legal Business Name | MEDIDEX LLC
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1711 E SUNSHINE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-1322
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Country | US
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Telephone | 417-883-1400
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Fax | 417-883-2663
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Provider Business Mailing Address
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Address Line | 555 E NORTH LN STE 5075
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-2490
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CCO
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Name | WENDY RUSSALESI
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Credential |
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Telephone | 484-246-9499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 11714034
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License Number State | MO
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