Provider Demographics
NPI:1700172186
Name:MEDYTOX MEDICAL MANAGEMENT SOLUTIONS CORP
Entity Type:Organization
Organization Name:MEDYTOX MEDICAL MANAGEMENT SOLUTIONS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FORHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-746-0623
Mailing Address - Street 1:1080 E INDIANTOWN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5100
Mailing Address - Country:US
Mailing Address - Phone:561-746-0623
Mailing Address - Fax:561-746-6844
Practice Address - Street 1:1080 E INDIANTOWN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5100
Practice Address - Country:US
Practice Address - Phone:561-746-0623
Practice Address - Fax:561-746-6844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory