Provider Demographics
NPI:1669910675
Name:TECH MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:TECH MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-462-9251
Mailing Address - Street 1:416 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3605
Mailing Address - Country:US
Mailing Address - Phone:813-724-3204
Mailing Address - Fax:585-433-5039
Practice Address - Street 1:416 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3605
Practice Address - Country:US
Practice Address - Phone:813-724-3204
Practice Address - Fax:585-433-5039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TECH MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center