Provider Demographics
NPI:1417429648
Name:IMPAKT MEDICAL, LLC
Entity Type:Organization
Organization Name:IMPAKT MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJERNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-844-7800
Mailing Address - Street 1:9722 FAIR OAKS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7039
Mailing Address - Country:US
Mailing Address - Phone:916-844-7800
Mailing Address - Fax:
Practice Address - Street 1:700 FREDERICK ST STE 301
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2239
Practice Address - Country:US
Practice Address - Phone:831-304-0700
Practice Address - Fax:916-436-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies