Provider Demographics
NPI:1992252720
Name:TECH MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:TECH MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-462-9251
Mailing Address - Street 1:605 CHURCH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3599
Mailing Address - Country:US
Mailing Address - Phone:912-387-2389
Mailing Address - Fax:912-712-1106
Practice Address - Street 1:605 CHURCH ST
Practice Address - Street 2:SUITE A
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3599
Practice Address - Country:US
Practice Address - Phone:912-387-2389
Practice Address - Fax:912-712-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center