Provider Demographics
NPI:1073054771
Name:IMED GROUP LLC
Entity Type:Organization
Organization Name:IMED GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:GENNARI LACERDA
Authorized Official - Last Name:JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-682-6874
Mailing Address - Street 1:144 N NARBERTH AVE
Mailing Address - Street 2:BOX 851
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 MARKET ST
Practice Address - Street 2:SUITE 1005
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3913
Practice Address - Country:US
Practice Address - Phone:215-825-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA28963601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health