Provider Demographics
NPI:1265548937
Name:INTERMED MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:INTERMED MEDICAL SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-534-0854
Mailing Address - Street 1:5145 PRESTON AVE
Mailing Address - Street 2:STE 190
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-2055
Mailing Address - Country:US
Mailing Address - Phone:281-534-0854
Mailing Address - Fax:281-534-0860
Practice Address - Street 1:5145 PRESTON AVE
Practice Address - Street 2:STE 190
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-2055
Practice Address - Country:US
Practice Address - Phone:281-534-0854
Practice Address - Fax:281-534-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186262502Medicaid
TX186262501Medicaid
TX186262501Medicaid