MEDICARE: MED-TECH OFFICE MANAGEMENT, LLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1669718490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-TECH OFFICE MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 1404
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459
Country	:	US
Telephone Number	:	832-398-2707
Fax Number	:	832-770-4396

Provider Business Practice Location Address
First Line	:	15402 BLUERIDGE CT
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-2606
Country	:	US
Telephone Number	:	832-893-8622
Fax Number	:	832-617-8755

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MRS. THEDA EDWARDS-LABOME
Credential	:	CODER
Telephone Number	:	830-398-2707

Provider Enumeration Date	:	12/26/2012
Last Update Date	:	05/03/2022

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