Provider Demographics
NPI:1891031225
Name:MEDTEK SPECIALTIES
Entity type:Organization
Organization Name:MEDTEK SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CONDOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-244-3590
Mailing Address - Street 1:P.O. BOX 383
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602
Mailing Address - Country:US
Mailing Address - Phone:337-494-3999
Mailing Address - Fax:337-494-0086
Practice Address - Street 1:1 LAKESHORE DR
Practice Address - Street 2:SUITE 1275
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70629-0100
Practice Address - Country:US
Practice Address - Phone:337-494-3999
Practice Address - Fax:337-494-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADME.000298332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies