Provider Demographics
NPI:1255668786
Name:IDAMED INC
Entity type:Organization
Organization Name:IDAMED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-556-4663
Mailing Address - Street 1:17660 NEWHOPE ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4296
Mailing Address - Country:US
Mailing Address - Phone:714-556-4663
Mailing Address - Fax:714-556-4664
Practice Address - Street 1:17660 NEWHOPE ST
Practice Address - Street 2:SUITE F
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4296
Practice Address - Country:US
Practice Address - Phone:714-556-4663
Practice Address - Fax:714-556-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255668786Medicaid
CA6374830001Medicare NSC