Provider Demographics
NPI:1912147729
Name:IMC CLINIC SERVICES CORPORATION
Entity Type:Organization
Organization Name:IMC CLINIC SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ALONZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-292-3030
Mailing Address - Street 1:25329 INTERSTATE 45 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3521
Mailing Address - Country:US
Mailing Address - Phone:281-292-3030
Mailing Address - Fax:281-292-1418
Practice Address - Street 1:25329 INTERSTATE 45 N
Practice Address - Street 2:SUITE B
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3521
Practice Address - Country:US
Practice Address - Phone:281-292-3030
Practice Address - Fax:281-292-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health