Provider Demographics
NPI:1023208113
Name:INCREDIBLE MEDICAL
Entity Type:Organization
Organization Name:INCREDIBLE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-854-7773
Mailing Address - Street 1:8847 WILSHIRE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3207
Mailing Address - Country:US
Mailing Address - Phone:310-854-7773
Mailing Address - Fax:323-653-3601
Practice Address - Street 1:8847 WILSHIRE BOULEVARD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3207
Practice Address - Country:US
Practice Address - Phone:310-854-7773
Practice Address - Fax:323-653-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies