Provider Demographics
NPI:1790757086
Name:MEDICAL TECHNOLOGY RESOURCES LLC
Entity Type:Organization
Organization Name:MEDICAL TECHNOLOGY RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:AMICON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-866-9516
Mailing Address - Street 1:1010 E TAYLOR STATION ROAD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230
Mailing Address - Country:US
Mailing Address - Phone:614-866-9516
Mailing Address - Fax:614-866-9520
Practice Address - Street 1:1010 E TAYLOR STATION ROAD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230
Practice Address - Country:US
Practice Address - Phone:614-866-9516
Practice Address - Fax:614-866-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2585966Medicaid
OH2585966Medicaid