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General NPI Number Information
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NPI Number | 1134702335
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Entity Type | Organization
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Legal Business Name | MED TECH HEALTHCARE SUPPLIES & ORTHODICS
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 1361 13TH AVE S STE 120
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3260
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Country | US
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Telephone | 904-509-7338
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Fax |
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Provider Business Mailing Address
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Address Line | 2693 SENECA DR
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City | ST JOHNS
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State | FL
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Zip | 32259-2122
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Country | US
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Telephone | 904-509-7338
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PAULA REECE-PATE
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Credential |
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Telephone | 904-509-7338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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