MEDICARE: INTERNATIONAL MEDIA ARTS CORPORATION

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	261QC1500X	Community Health Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1700277795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL MEDIA ARTS CORPORATION

Provider Business Mailing Address
First Line	:	24237 MAIN ST
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-2907
Country	:	US
Telephone Number	:	661-259-6302
Fax Number	:	661-259-6309

Provider Business Practice Location Address
First Line	:	24237 MAIN ST
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-2907
Country	:	US
Telephone Number	:	661-259-6302
Fax Number	:	661-259-6309

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MUSABBIR HOSSAIN CHOWDHURY
Credential	:
Telephone Number	:	661-259-6302

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	08/05/2019

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