Provider Demographics
NPI:1134702335
Name:MED TECH HEALTHCARE SUPPLIES & ORTHODICS
Entity Type:Organization
Organization Name:MED TECH HEALTHCARE SUPPLIES & ORTHODICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:REECE-PATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-509-7338
Mailing Address - Street 1:2693 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2122
Mailing Address - Country:US
Mailing Address - Phone:904-509-7338
Mailing Address - Fax:
Practice Address - Street 1:1361 13TH AVE S STE 120
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3260
Practice Address - Country:US
Practice Address - Phone:904-509-7338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier