Healthcare Provider Details

I. General information

NPI: 1265702922
Provider Name (Legal Business Name): INTERACTIVE MEDICAL SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 W 7250 S
MIDVALE UT
84047-1060
US

IV. Provider business mailing address

12882 VALLEY VIEW ST STE 9
GARDEN GROVE CA
92845-2519
US

V. Phone/Fax

Practice location:
  • Phone: 714-894-5029
  • Fax: 310-227-8229
Mailing address:
  • Phone: 714-894-5029
  • Fax: 310-227-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LYNETTE POWELL
Title or Position: MANAGER
Credential:
Phone: 714-894-5029