Provider Demographics
NPI:1891806139
Name:MEDICAL TECHNOLOGIES LLC
Entity Type:Organization
Organization Name:MEDICAL TECHNOLOGIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ROCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-252-8164
Mailing Address - Street 1:919 W WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4921
Mailing Address - Country:US
Mailing Address - Phone:580-252-8164
Mailing Address - Fax:580-255-1516
Practice Address - Street 1:919 W WILLOW AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4921
Practice Address - Country:US
Practice Address - Phone:580-252-8164
Practice Address - Fax:580-255-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5019970001Medicare ID - Type UnspecifiedMEDICARE