Healthcare Provider Details

I. General information

NPI: 1790757086
Provider Name (Legal Business Name): MEDICAL TECHNOLOGY RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E TAYLOR STATION ROAD
GAHANNA OH
43230
US

IV. Provider business mailing address

1010 E TAYLOR STATION ROAD
GAHANNA OH
43230
US

V. Phone/Fax

Practice location:
  • Phone: 614-866-9516
  • Fax: 614-866-9520
Mailing address:
  • Phone: 614-866-9516
  • Fax: 614-866-9520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW ROBERT AMICON
Title or Position: PRESIDENT CEO
Credential:
Phone: 614-866-9516