Provider Demographics
NPI:1114053154
Name:IME MEDICAL CORPORATION
Entity Type:Organization
Organization Name:IME MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:IMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-931-4015
Mailing Address - Street 1:401 W WATERS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2940
Mailing Address - Country:US
Mailing Address - Phone:813-931-4015
Mailing Address - Fax:
Practice Address - Street 1:401 W WATERS AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-2940
Practice Address - Country:US
Practice Address - Phone:813-931-4015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1783332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025870900Medicaid
FLR9412OtherBCBS FL PROVIDER
FL025870900Medicaid