1073708574 NPI number — INTERNATIONAL MEDICAL SERVICES

Table of content: (NPI 1073708574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073708574 NPI number — INTERNATIONAL MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNATIONAL MEDICAL SERVICES
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:
1073708574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9511 99TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OZONE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11416-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-322-2688
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8915 175TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-5533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-739-4848
Provider Business Practice Location Address Fax Number:
718-739-2229
Provider Enumeration Date:
09/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONTENEGRO
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
AUGUSTO
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
718-322-2688

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  227588 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05807 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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