Provider Demographics
NPI:1245209451
Name:MED-TEK SYSTEMS
Entity Type:Organization
Organization Name:MED-TEK SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-861-4525
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-1001
Mailing Address - Country:US
Mailing Address - Phone:901-861-4525
Mailing Address - Fax:901-861-3193
Practice Address - Street 1:432 HIGHWAY 72
Practice Address - Street 2:SUITE 3B
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2808
Practice Address - Country:US
Practice Address - Phone:901-861-4525
Practice Address - Fax:901-861-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000494332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440010Medicaid
TN3562516Medicaid
TN002008218OtherBLUECROSS/BLUESHIELD
AR122481716Medicaid
TN002008218OtherBLUECROSS/BLUESHIELD