Provider Demographics
NPI:1700433067
Name:IMPACT MEDICAL SUPPLIES AND SERVICES, LLC.
Entity Type:Organization
Organization Name:IMPACT MEDICAL SUPPLIES AND SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARELOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-569-1288
Mailing Address - Street 1:990 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-5008
Mailing Address - Country:US
Mailing Address - Phone:352-569-1288
Mailing Address - Fax:352-608-9269
Practice Address - Street 1:990 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-5008
Practice Address - Country:US
Practice Address - Phone:525-691-2883
Practice Address - Fax:352-608-9269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment