1003826587 NPI number — HI-TECH HEALTHCARE INC.

Table of content: (NPI 1003826587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003826587 NPI number — HI-TECH HEALTHCARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HI-TECH HEALTHCARE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003826587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 SHACKLEFORD CT
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30093-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-449-6785
Provider Business Mailing Address Fax Number:
770-449-0648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1233 HIGHWAY 54 W
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214-4542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-460-7744
Provider Business Practice Location Address Fax Number:
770-460-7864
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TYSON
Authorized Official First Name:
GARY
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-449-6785

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00428678D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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