Healthcare Provider Details

I. General information

NPI: 1376916379
Provider Name (Legal Business Name): IMPACT MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NW VESPER ST
BLUE SPRINGS MO
64015-3667
US

IV. Provider business mailing address

1001 NW VESPER ST
BLUE SPRINGS MO
64015-3667
US

V. Phone/Fax

Practice location:
  • Phone: 816-622-1017
  • Fax: 866-229-0034
Mailing address:
  • Phone: 816-622-1017
  • Fax: 866-229-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1644636
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER CURRAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 573-673-1510