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General NPI Number Information
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NPI Number | 1669910675
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Entity Type | Organization
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Legal Business Name | TECH MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 416 E 3RD AVE
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City | CORDELE
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State | GA
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Zip | 31015-3605
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Country | US
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Telephone | 813-724-3204
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Fax | 585-433-5039
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Provider Business Mailing Address
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Address Line | 416 E 3RD AVE
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City | CORDELE
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State | GA
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Zip | 31015-3605
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Country | US
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Telephone | 813-724-3204
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Fax | 585-433-5039
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. JOSE MIGUEL LOPEZ
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Credential | M.D.
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Telephone | 646-462-9251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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