Provider Demographics
NPI:1972357192
Name:MEDACCESS RX LLC
Entity type:Organization
Organization Name:MEDACCESS RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:FACHM
Authorized Official - Phone:727-455-7486
Mailing Address - Street 1:2100 BILLMAR LN N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2648
Mailing Address - Country:US
Mailing Address - Phone:727-455-7486
Mailing Address - Fax:
Practice Address - Street 1:2100 BILLMAR LN N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2648
Practice Address - Country:US
Practice Address - Phone:727-455-7486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDACCESS RX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No251B00000XAgenciesCase Management
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty