Provider Demographics
NPI:1902116932
Name:DAXX MEDICAL SERVICES INC.
Entity Type:Organization
Organization Name:DAXX MEDICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ENO
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-368-5003
Mailing Address - Street 1:5817 N KENMORE AVE
Mailing Address - Street 2:#604
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3773
Mailing Address - Country:US
Mailing Address - Phone:773-368-5003
Mailing Address - Fax:
Practice Address - Street 1:3615 PARK DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1098
Practice Address - Country:US
Practice Address - Phone:773-368-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid