Provider Demographics
NPI:1821317520
Name:DURATECH MEDICAL, INC.
Entity Type:Organization
Organization Name:DURATECH MEDICAL, INC.
Other - Org Name:BREG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-795-5440
Mailing Address - Street 1:2382 FARADAY AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7220
Mailing Address - Country:US
Mailing Address - Phone:760-795-5440
Mailing Address - Fax:214-501-0299
Practice Address - Street 1:1608 WILLIAMS DR STE 201
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3195
Practice Address - Country:US
Practice Address - Phone:615-599-7600
Practice Address - Fax:615-599-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1821317520Medicaid
KY7100164790Medicaid
KY7100164790Medicaid