Provider Demographics
NPI:1932773256
Name:IMAGINE MEDICAL INTERNATIONAL LLC
Entity Type:Organization
Organization Name:IMAGINE MEDICAL INTERNATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVANIKA
Authorized Official - Middle Name:KHANNA
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-323-9093
Mailing Address - Street 1:10151 DEERWOOD PARK BLVD STE 200-250
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0589
Mailing Address - Country:US
Mailing Address - Phone:904-486-0746
Mailing Address - Fax:
Practice Address - Street 1:10151 DEERWOOD PARK BLVD STE 200-250
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0589
Practice Address - Country:US
Practice Address - Phone:904-486-0746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies