Provider Demographics
NPI:1457893794
Name:MEDTECH ENGINUITY CORP.
Entity Type:Organization
Organization Name:MEDTECH ENGINUITY CORP.
Other - Org Name:MEDTEC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-512-9899
Mailing Address - Street 1:12125 GUINEVERE PL
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2203
Mailing Address - Country:US
Mailing Address - Phone:301-352-0344
Mailing Address - Fax:301-761-3302
Practice Address - Street 1:12125 GUINEVERE PL
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-2203
Practice Address - Country:US
Practice Address - Phone:301-352-0344
Practice Address - Fax:301-761-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD302R00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No302R00000XManaged Care OrganizationsHealth Maintenance Organization