Provider Demographics
NPI:1093529463
Name:IMPAKT MEDICAL, LLC
Entity type:Organization
Organization Name:IMPAKT MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BATEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-844-7800
Mailing Address - Street 1:9722 FAIR OAKS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7039
Mailing Address - Country:US
Mailing Address - Phone:408-480-5811
Mailing Address - Fax:916-436-9054
Practice Address - Street 1:1700 S EL CAMINO REAL STE 204
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3048
Practice Address - Country:US
Practice Address - Phone:650-844-8801
Practice Address - Fax:916-436-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies