=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043649825
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMPAIRMENT SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2013
-----------------------------------------------------
Last Update Date | 11/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10109 MCKALLA PL STE E
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-4449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-970-8490
-----------------------------------------------------
Fax | 800-482-0591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10109 MCKALLA PL STE E
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-4449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-970-8490
-----------------------------------------------------
Fax | 800-482-0591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | LEON STEARNS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-970-8490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 202C00000X
-----------------------------------------------------
Taxonomy Name | Independent Medical Examiner Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------