Provider Demographics
NPI:1700839131
Name:MEDI TECH, INC.
Entity Type:Organization
Organization Name:MEDI TECH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:O. G.
Authorized Official - Middle Name:G
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:501-250-0300
Mailing Address - Street 1:1031 HWY 25B NORTH
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-2034
Mailing Address - Country:US
Mailing Address - Phone:501-250-0300
Mailing Address - Fax:501-250-0309
Practice Address - Street 1:1031 HWY 25B NORTH
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2034
Practice Address - Country:US
Practice Address - Phone:501-250-0300
Practice Address - Fax:501-250-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty