MEDICARE: INTERACTIVE MEDICAL SYSTEMS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1053412049	OTHER	CA	MEDI-CAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053412049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERACTIVE MEDICAL SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	12882 VALLEY VIEW ST
Second Line	:	SUITE 8
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2519
Country	:	US
Telephone Number	:	714-894-5029
Fax Number	:	310-227-8229

Provider Business Practice Location Address
First Line	:	12882 VALLEY VIEW ST
Second Line	:	SUITE 8
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2519
Country	:	US
Telephone Number	:	714-894-5029
Fax Number	:	310-227-8229

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. LYNETTE POWELL
Credential	:
Telephone Number	:	714-894-5029

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	11/07/2014

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