Provider Demographics
NPI:1326337411
Name:INTERNATIONAL MEDICAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:INTERNATIONAL MEDICAL MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:817-800-5630
Mailing Address - Street 1:2716 COUNTY ROAD 804A
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1950
Mailing Address - Country:US
Mailing Address - Phone:817-800-5630
Mailing Address - Fax:817-447-9958
Practice Address - Street 1:2716 COUNTY ROAD 804A
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-1950
Practice Address - Country:US
Practice Address - Phone:817-800-5630
Practice Address - Fax:817-447-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8174478426OtherHOME OFFICE NUMBER