Provider Demographics
NPI:1386864312
Name:MED TEL INTERNATIONAL CORPORATION
Entity Type:Organization
Organization Name:MED TEL INTERNATIONAL CORPORATION
Other - Org Name:WIDE OPEN MRI OR WIDE OPEN IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMPSON
Authorized Official - Middle Name:S
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-236-4640
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-8744
Mailing Address - Country:US
Mailing Address - Phone:703-448-8800
Mailing Address - Fax:703-448-8515
Practice Address - Street 1:1430 SPRING HILL RD
Practice Address - Street 2:SUITE 500
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3000
Practice Address - Country:US
Practice Address - Phone:703-448-8800
Practice Address - Fax:703-448-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9296174Medicare ID - Type UnspecifiedGROUP PIN MARION
OH9296171Medicare ID - Type UnspecifiedGROUP PIN TOLEDO
PA039531N7WMedicare PIN
TX00688RMedicare PIN
DEG00206Medicare PIN
MD193MMedicare ID - Type UnspecifiedGROUP PIN WESTMINSTER
MD192MMedicare PIN
OH926173Medicare ID - Type UnspecifiedGROUP PIN FINDLAY
OH9296172Medicare ID - Type UnspecifiedGROUP PIN MARIETTA