Provider Demographics
NPI:1891066197
Name:INTERACTIVE MEDICAL SYSTEMS
Entity Type:Organization
Organization Name:INTERACTIVE MEDICAL SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-487-3031
Mailing Address - Street 1:12882 VALLEY VIEW ST
Mailing Address - Street 2:STE 9
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2519
Mailing Address - Country:US
Mailing Address - Phone:714-894-5029
Mailing Address - Fax:310-227-8229
Practice Address - Street 1:16588 SW 72ND AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7755
Practice Address - Country:US
Practice Address - Phone:888-877-0209
Practice Address - Fax:888-877-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR332B00000XOtherDURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES