Provider Demographics
NPI:1457867574
Name:PHYSICIANS TECHNOLOGY, LLC
Entity Type:Organization
Organization Name:PHYSICIANS TECHNOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:FIEMA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:734-241-5060
Mailing Address - Street 1:23 E FRONT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2210
Mailing Address - Country:US
Mailing Address - Phone:734-241-5060
Mailing Address - Fax:
Practice Address - Street 1:23 E FRONT ST STE 200
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2210
Practice Address - Country:US
Practice Address - Phone:734-241-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care