Provider Demographics
NPI:1427107689
Name:MED TECH EXPRESS
Entity type:Organization
Organization Name:MED TECH EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ROCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-252-8164
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-0391
Mailing Address - Country:US
Mailing Address - Phone:580-252-8164
Mailing Address - Fax:580-255-1516
Practice Address - Street 1:1845 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1413
Practice Address - Country:US
Practice Address - Phone:580-252-9797
Practice Address - Fax:580-252-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5019970002Medicare ID - Type UnspecifiedMEDICARE