Provider Demographics
NPI:1295044824
Name:MEDICAL TECHNOLOGY TRANSFER CORPORATION
Entity Type:Organization
Organization Name:MEDICAL TECHNOLOGY TRANSFER CORPORATION
Other - Org Name:4CARE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-726-1604
Mailing Address - Street 1:590 MALABAR ROAD, SUITE 6
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907
Mailing Address - Country:US
Mailing Address - Phone:321-676-3535
Mailing Address - Fax:321-676-3575
Practice Address - Street 1:590 MALABAR ROAD, SUITE 6
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907
Practice Address - Country:US
Practice Address - Phone:321-676-3535
Practice Address - Fax:321-676-3575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL TECHNOLOGY TRANSFER CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-30
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care