Provider Demographics
NPI:1316934094
Name:MRT MEDICAL
Entity type:Organization
Organization Name:MRT MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-381-9311
Mailing Address - Street 1:340 LEGION DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2716
Mailing Address - Country:US
Mailing Address - Phone:859-381-9311
Mailing Address - Fax:859-225-5841
Practice Address - Street 1:340 LEGION DR
Practice Address - Street 2:SUITE 12
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2716
Practice Address - Country:US
Practice Address - Phone:859-381-9311
Practice Address - Fax:859-225-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90000829Medicaid
KY90000829Medicaid