Healthcare Provider Details

I. General information

NPI: 1780767012
Provider Name (Legal Business Name): MED TECH IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E SUNRISE BLVD
FORT LAUDERDALE FL
33304-3044
US

IV. Provider business mailing address

2000 E SUNRISE BLVD
FORT LAUDERDALE FL
33304-3044
US

V. Phone/Fax

Practice location:
  • Phone: 954-766-6060
  • Fax: 954-341-3400
Mailing address:
  • Phone: 954-766-6060
  • Fax: 954-341-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDALL AUCLAIR
Title or Position: PRESIDENT
Credential:
Phone: 954-766-6060