Provider Demographics
NPI:1003055641
Name:IMPLAN
Entity Type:Organization
Organization Name:IMPLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-907-8263
Mailing Address - Street 1:6151 LAKE OSPREY DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8419
Mailing Address - Country:US
Mailing Address - Phone:866-526-8412
Mailing Address - Fax:866-526-8413
Practice Address - Street 1:6151 LAKE OSPREY DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8419
Practice Address - Country:US
Practice Address - Phone:866-526-8412
Practice Address - Fax:866-526-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies