Basic Information
| Provider Information | |||||||||
| NPI: | 1003826587 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HI-TECH HEALTHCARE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1805 SHACKLEFORD CT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300932924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704496785 | ||||||||
| FaxNumber: | 7704490648 | ||||||||
| Practice Location | |||||||||
| Address1: | 1233 HIGHWAY 54 W | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704607744 | ||||||||
| FaxNumber: | 7704607864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 09/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | TYSON | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | TODD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7704496785 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | BS,RRT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 332BX2000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 00428678D | 05 | GA | MEDICAID |