=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700839131
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDI TECH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1031 HWY 25B NORTH
-----------------------------------------------------
City | HEBER SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72543-2034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-250-0300
-----------------------------------------------------
Fax | 501-250-0309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1031 HWY 25B NORTH
-----------------------------------------------------
City | HEBER SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72543-2034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-250-0300
-----------------------------------------------------
Fax | 501-250-0309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. O. G. G. VANCE
-----------------------------------------------------
Credential | BC-HIS
-----------------------------------------------------
Telephone | 501-250-0300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 226
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------