Provider Demographics
NPI:1043416951
Name:INTERNATIONAL MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:INTERNATIONAL MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:O
Authorized Official - Last Name:MADOJEMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-292-5500
Mailing Address - Street 1:3100 LONDON BLVED #1
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3234
Mailing Address - Country:US
Mailing Address - Phone:757-295-5500
Mailing Address - Fax:757-295-0480
Practice Address - Street 1:3100 LONDON BLVED #1
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3234
Practice Address - Country:US
Practice Address - Phone:757-295-5500
Practice Address - Fax:757-295-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332S00000XSuppliersHearing Aid Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier