Provider Demographics
NPI:1063809465
Name:IMED PHYSICIAN NETWORK, INC.
Entity type:Organization
Organization Name:IMED PHYSICIAN NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-865-4454
Mailing Address - Street 1:2700 W PLEASANT RUN RD STE 340
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1074
Mailing Address - Country:US
Mailing Address - Phone:972-865-4454
Mailing Address - Fax:214-888-4450
Practice Address - Street 1:2700 W PLEASANT RUN RD STE 340
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1074
Practice Address - Country:US
Practice Address - Phone:972-865-4454
Practice Address - Fax:214-888-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty