=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851403968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMART TECH MEDICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 01/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 N DIXIE HWY SUITE 115
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-1850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-887-6153
-----------------------------------------------------
Fax | 305-887-7340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 N DIXIE HWY SUITE 115
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-1850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-887-6153
-----------------------------------------------------
Fax | 305-887-7340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR DIRECTOR
-----------------------------------------------------
Name | MR. STEVE HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-887-6153
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------