Provider Demographics
NPI:1659685386
Name:IMPEDIMED INC
Entity Type:Organization
Organization Name:IMPEDIMED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT GLOBAL OPS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SIPES
Authorized Official - Last Name:HONEYCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:BSME
Authorized Official - Phone:858-412-0200
Mailing Address - Street 1:5959 CORNERSTONE CT W STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3764
Mailing Address - Country:US
Mailing Address - Phone:858-412-0200
Mailing Address - Fax:858-558-8540
Practice Address - Street 1:5959 CORNERSTONE CT W STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3764
Practice Address - Country:US
Practice Address - Phone:858-412-0200
Practice Address - Fax:858-558-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies