1891066197 NPI number — INTERACTIVE MEDICAL SYSTEMS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891066197 NPI number — INTERACTIVE MEDICAL SYSTEMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERACTIVE MEDICAL SYSTEMS
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:
1891066197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12882 VALLEY VIEW ST
Provider Second Line Business Mailing Address:
STE 9
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92845-2519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-894-5029
Provider Business Mailing Address Fax Number:
310-227-8229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16588 SW 72ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIGARD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97224-7755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-877-0209
Provider Business Practice Location Address Fax Number:
888-877-0212
Provider Enumeration Date:
01/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
REITZ
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
626-487-3031

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 332B00000X . This is a "DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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