Healthcare Provider Details

I. General information

NPI: 1093048944
Provider Name (Legal Business Name): IMEDICAL GROUP,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 ALLEGHENY BLVD SUITE C
BROOKVILLE PA
15825-2327
US

IV. Provider business mailing address

PO BOX 500
BROOKVILLE PA
15825-0500
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-2003
  • Fax: 814-715-7009
Mailing address:
  • Phone: 814-849-2003
  • Fax: 814-715-7009

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DAVID BRIAN GAFFNEY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 814-849-2003