Provider Demographics
NPI:1164846192
Name:IMED RESOURCE GROUP
Entity Type:Organization
Organization Name:IMED RESOURCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:HOLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-493-9551
Mailing Address - Street 1:11201 RICHMOND AVE
Mailing Address - Street 2:SUITE A106
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-6653
Mailing Address - Country:US
Mailing Address - Phone:281-493-9551
Mailing Address - Fax:281-493-9668
Practice Address - Street 1:11201 RICHMOND AVE
Practice Address - Street 2:SUITE A106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6653
Practice Address - Country:US
Practice Address - Phone:281-493-9551
Practice Address - Fax:281-493-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies