Provider Demographics
NPI:1457485054
Name:MED TEL INTERNATIONAL CORPORATION
Entity Type:Organization
Organization Name:MED TEL INTERNATIONAL CORPORATION
Other - Org Name:WIDE OPEN IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-873-9850
Mailing Address - Street 1:1430 SPRING HILL RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3000
Mailing Address - Country:US
Mailing Address - Phone:703-287-4189
Mailing Address - Fax:703-448-1807
Practice Address - Street 1:800 PIKE ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3507
Practice Address - Country:US
Practice Address - Phone:740-374-7500
Practice Address - Fax:740-374-8802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED TEL INTERNATIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0446IC261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2653570Medicaid
OH9296172Medicare PIN