Provider Demographics
NPI:1093959298
Name:IMPUNITUS LLC
Entity Type:Organization
Organization Name:IMPUNITUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:SLOVACEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-846-4667
Mailing Address - Street 1:PO BOX 5294
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-5294
Mailing Address - Country:US
Mailing Address - Phone:979-846-4667
Mailing Address - Fax:866-703-2713
Practice Address - Street 1:414A TARROW ST
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-7811
Practice Address - Country:US
Practice Address - Phone:979-846-4667
Practice Address - Fax:866-703-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Single Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy CareGroup - Single Specialty