Provider Demographics
NPI:1073743662
Name:MEDTECH OF CORINTH
Entity Type:Organization
Organization Name:MEDTECH OF CORINTH
Other - Org Name:MEDTECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DUSTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-665-9800
Mailing Address - Street 1:207 N HARPER RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-5271
Mailing Address - Country:US
Mailing Address - Phone:662-665-9800
Mailing Address - Fax:662-665-9834
Practice Address - Street 1:207 N HARPER RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-5271
Practice Address - Country:US
Practice Address - Phone:662-665-9800
Practice Address - Fax:662-665-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05685/11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies