Provider Demographics
NPI:1184829939
Name:MEDICAL TECHNOLOGY, INC.
Entity type:Organization
Organization Name:MEDICAL TECHNOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-647-0884
Mailing Address - Street 1:2601 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3516
Mailing Address - Country:US
Mailing Address - Phone:972-647-0884
Mailing Address - Fax:972-606-0946
Practice Address - Street 1:2601 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3516
Practice Address - Country:US
Practice Address - Phone:972-647-0884
Practice Address - Fax:972-606-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier