Provider Demographics
NPI:1205173853
Name:MEDTECH ENTERPRISES
Entity type:Organization
Organization Name:MEDTECH ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LENNIE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-461-0129
Mailing Address - Street 1:2158 NORTHGATE PARK LN
Mailing Address - Street 2:408
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-6957
Mailing Address - Country:US
Mailing Address - Phone:800-461-0129
Mailing Address - Fax:800-315-0982
Practice Address - Street 1:28070 E STATE RD STE 2
Practice Address - Street 2:
Practice Address - City:ISLAND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60042-9552
Practice Address - Country:US
Practice Address - Phone:800-461-0129
Practice Address - Fax:800-315-0982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment