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General NPI Number Information
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NPI Number | 1003055641
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Entity Type | Organization
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Legal Business Name | IMPLAN
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 6151 LAKE OSPREY DR 3RD FLOOR
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City | SARASOTA
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State | FL
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Zip | 34240-8419
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Country | US
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Telephone | 866-526-8412
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Fax | 866-526-8413
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Provider Business Mailing Address
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Address Line | 6151 LAKE OSPREY DR 3RD FLOOR
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City | SARASOTA
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State | FL
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Zip | 34240-8419
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Country | US
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Telephone | 866-526-8412
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Fax | 866-526-8413
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KELLY ALAN POWERS
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Credential |
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Telephone | 941-907-8263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | FL
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