Provider Demographics
NPI:1104947217
Name:MEDICAL TECHNOLOGY TRANSFER CORPORATION
Entity type:Organization
Organization Name:MEDICAL TECHNOLOGY TRANSFER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-726-1609
Mailing Address - Street 1:1800 W HIBISCUS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2624
Mailing Address - Country:US
Mailing Address - Phone:321-726-1600
Mailing Address - Fax:321-726-1610
Practice Address - Street 1:1800 W HIBISCUS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2624
Practice Address - Country:US
Practice Address - Phone:321-726-1600
Practice Address - Fax:321-726-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40166AMedicare ID - Type Unspecified