Healthcare Provider Details

I. General information

NPI: 1700839131
Provider Name (Legal Business Name): MEDI TECH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 HWY 25B NORTH
HEBER SPRINGS AR
72543-2034
US

IV. Provider business mailing address

1031 HWY 25B NORTH
HEBER SPRINGS AR
72543-2034
US

V. Phone/Fax

Practice location:
  • Phone: 501-250-0300
  • Fax: 501-250-0309
Mailing address:
  • Phone: 501-250-0300
  • Fax: 501-250-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number226
License Number StateAR

VIII. Authorized Official

Name: MR. O. G. G. VANCE
Title or Position: OWNER
Credential: BC-HIS
Phone: 501-250-0300