1720664808 NPI number — TECHNOLOGY & MEDICAL STORE INC

Table of content: (NPI 1720664808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720664808 NPI number — TECHNOLOGY & MEDICAL STORE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TECHNOLOGY & MEDICAL STORE INC
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:
Provider Other Organization Name Type Code:
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:
1720664808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6418 S ACACIA DESERT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85706-3026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-955-0941
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S LA CANADA DR STE 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREEN VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85614-2665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-333-2599
Provider Business Practice Location Address Fax Number:
520-800-8781
Provider Enumeration Date:
03/19/2021

Additional Information

Authorized Official

Authorized Official Last Name:
VALENZUELA
Authorized Official First Name:
MOSES
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
FRANCHISE OWNER
Authorized Official Telephone Number:
520-333-2599

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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