NPIMap

Organization Active NPI

Med Tel Interantional Corporation

  • Physiological Laboratory
  • Wichita Falls, TX
National Provider Identifier
1639203284
Registry record updated Aug 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
MED TEL INTERANTIONAL CORPORATION
Practice address
1515 10TH St
Wichita Falls, TX 76301-4404
Phone
(940) 766-5242
Fax
(940) 766-0449
NPI assigned
Mar 15, 2007
Organization subpart
Yes
Parent organization
MED TEL INTERNATIONAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Valla
Title
Vice President
Phone
(937) 873-9850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X TX Primary

Addresses

Primary practice location

1515 10TH St
Wichita Falls, TX 76301-4404

Mailing address

1430 Spring Hill Rd
Suite 500
McLean, VA 22102-3000
Phone (703) 287-4189

Other identifiers 1

IdentifierTypeStateIssuer
163697901MedicaidTX

Other names 1

  • Wide Open MRI Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Med-Tel Intrntl Corp5 organizations share this tax ID, including this one
Part of
Med-Tel Intrntl Corp

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1515 10th St
Wichita Falls, TX 76301
Phone (940) 500-4263

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219708800000",
    "number": "1639203284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 SPRING HILL RD",
            "address_2": "SUITE 500",
            "city": "MCLEAN",
            "state": "VA",
            "postal_code": "221023000",
            "telephone_number": "703-287-4189",
            "fax_number": "703-448-1807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 10TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763014404",
            "telephone_number": "940-766-5242",
            "fax_number": "940-766-0449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED TEL INTERANTIONAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MED TEL INTERNATIONAL CORPORATION",
        "enumeration_date": "2007-03-15",
        "last_updated": "2008-08-26",
        "status": "A",
        "authorized_official_last_name": "VALLA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "937-873-9850"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163697901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wide Open MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.