Healthcare Provider Details

I. General information

NPI: 1275975120
Provider Name (Legal Business Name): IN MED SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2013
Last Update Date: 07/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

2006 CALDBECK LN
FRESNO TX
77545-6087
US

V. Phone/Fax

Practice location:
  • Phone: 713-538-8163
  • Fax:
Mailing address:
  • Phone: 713-538-8163
  • Fax: 713-538-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMUNOMIEBAKA OPUIYO
Title or Position: OWNER
Credential: RDMS
Phone: 832-647-1095