Provider Demographics
NPI:1407810864
Name:IMUDANI MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:IMUDANI MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UDOM
Authorized Official - Middle Name:
Authorized Official - Last Name:UFOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-251-0369
Mailing Address - Street 1:2401 W PECAN ST
Mailing Address - Street 2:106
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3200
Mailing Address - Country:US
Mailing Address - Phone:512-251-0369
Mailing Address - Fax:512-251-9390
Practice Address - Street 1:2401 W PECAN ST
Practice Address - Street 2:106
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3200
Practice Address - Country:US
Practice Address - Phone:512-251-0369
Practice Address - Fax:512-251-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0060391332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4455200001Medicare ID - Type Unspecified