Provider Demographics
NPI:1295738912
Name:MEDTECH, INC
Entity type:Organization
Organization Name:MEDTECH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:KING
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:662-665-9800
Mailing Address - Street 1:207 N HARPER RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-5271
Mailing Address - Country:US
Mailing Address - Phone:662-665-9800
Mailing Address - Fax:
Practice Address - Street 1:207 N HARPER RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-5271
Practice Address - Country:US
Practice Address - Phone:662-665-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05685/11.1332BX2000X
MS05774/02.0333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00441018Medicaid
MS4602680001Medicare ID - Type Unspecified