MEDICARE: MED TECH HEALTHCARE SUPPLIES & ORTHODICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1134702335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED TECH HEALTHCARE SUPPLIES & ORTHODICS

Provider Business Mailing Address
First Line	:	2693 SENECA DR
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-2122
Country	:	US
Telephone Number	:	904-509-7338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1361 13TH AVE S STE 120
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3260
Country	:	US
Telephone Number	:	904-509-7338
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PAULA REECE-PATE
Credential	:
Telephone Number	:	904-509-7338

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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