Provider Demographics
NPI:1083731798
Name:IMPERIAL MEDICAL MANAGEMENR, INC.
Entity Type:Organization
Organization Name:IMPERIAL MEDICAL MANAGEMENR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:IRENEUSZ
Authorized Official - Last Name:SZYMCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-674-2424
Mailing Address - Street 1:18285 COLLIER AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530
Mailing Address - Country:US
Mailing Address - Phone:951-674-2424
Mailing Address - Fax:951-674-5656
Practice Address - Street 1:27297 LINDELL RD
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-7341
Practice Address - Country:US
Practice Address - Phone:951-674-2424
Practice Address - Fax:951-674-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5992160001Medicare NSC