1275590903 NPI number — MED TEL INTERNATIONAL CORPORATION

Table of content: (NPI 1275590903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275590903 NPI number — MED TEL INTERNATIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED TEL INTERNATIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WIDE OPEN MRI IMAGING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275590903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 SPRING HILL RD
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
MC LEAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22102-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-287-4189
Provider Business Mailing Address Fax Number:
703-448-8180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MILFORD ST
Provider Second Line Business Practice Location Address:
SUITE 602
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-6953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-546-4300
Provider Business Practice Location Address Fax Number:
410-860-1810
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VALLA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
973-873-9850

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  M140C , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 17600100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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