1154342160 NPI number — IMED, INC.

Table of content: (NPI 1154342160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154342160 NPI number — IMED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMED, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
I&O MEDICAL CENTERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154342160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 THIMBLE SHOALS BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-4544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-240-5580
Provider Business Mailing Address Fax Number:
757-240-5578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
838 OLD GEORGE WASHINGTON HWY N
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23323-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-487-9600
Provider Business Practice Location Address Fax Number:
757-487-6090
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BADDAR
Authorized Official First Name:
N.
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
757-825-1100

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 383493 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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