=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316934094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MRT MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2005
-----------------------------------------------------
Last Update Date | 12/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 LEGION DR SUITE 12
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40504-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-381-9311
-----------------------------------------------------
Fax | 859-225-5841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 LEGION DR SUITE 12
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40504-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-381-9311
-----------------------------------------------------
Fax | 859-225-5841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | MR. SAMUEL LORENZO MCGUIRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-381-9311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------