Provider Demographics
NPI:1962438432
Name:TEGA INC
Entity type:Organization
Organization Name:TEGA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-632-3772
Mailing Address - Street 1:2650 I 75 BUSINESS SPUR
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3536
Mailing Address - Country:US
Mailing Address - Phone:906-632-3772
Mailing Address - Fax:906-632-0309
Practice Address - Street 1:2650 I 75 BUSINESS SPUR
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3536
Practice Address - Country:US
Practice Address - Phone:906-632-3772
Practice Address - Fax:906-632-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2899329Medicaid
MIOA70445OtherBLUE CROSS BLUE SHIELD
MI2899329Medicaid