Healthcare Provider Details

I. General information

NPI: 1487898771
Provider Name (Legal Business Name): I MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W STATE ROAD 434
LONGWOOD FL
32750-5159
US

IV. Provider business mailing address

420 W STATE ROAD 434
LONGWOOD FL
32750-5159
US

V. Phone/Fax

Practice location:
  • Phone: 407-767-8666
  • Fax: 321-256-0664
Mailing address:
  • Phone: 407-767-8666
  • Fax: 321-256-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN O. IDEHEN
Title or Position: PRESIDENT
Credential: MS. OTR/L CFO
Phone: 407-767-8666