MEDICARE: MED TEL INTERANTIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639203284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED TEL INTERANTIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1430 SPRING HILL RD
Second Line	:	SUITE 500
City	:	MCLEAN
State	:	VA
Zip	:	22102-3000
Country	:	US
Telephone Number	:	703-287-4189
Fax Number	:	703-448-1807

Provider Business Practice Location Address
First Line	:	1515 10TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4404
Country	:	US
Telephone Number	:	940-766-5242
Fax Number	:	940-766-0449

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JOHN VALLA
Credential	:
Telephone Number	:	937-873-9850

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/26/2008

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