Provider Demographics
NPI:1417972381
Name:IMPERIAL MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:IMPERIAL MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-700-9565
Mailing Address - Street 1:16666 EAST JOHNSON DR
Mailing Address - Street 2:SUITE # C
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91745-2412
Mailing Address - Country:US
Mailing Address - Phone:800-700-9565
Mailing Address - Fax:800-450-3718
Practice Address - Street 1:16666 E JOHNSON DR
Practice Address - Street 2:SUITE # C
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91745-2412
Practice Address - Country:US
Practice Address - Phone:800-700-9565
Practice Address - Fax:800-450-3718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101028332B00000X, 332BC3200X, 332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02353FOtherMEDI-CAL PROVIDER NUMBER
CADME02353FOtherMEDI-CAL PROVIDER NUMBER