Provider Demographics
NPI:1194058453
Name:INTERACTIVE MEDICAL SYSTEMS, INC.
Entity type:Organization
Organization Name:INTERACTIVE MEDICAL SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-894-5029
Mailing Address - Street 1:1107 FAIR OAKS AVE
Mailing Address - Street 2:432
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3311
Mailing Address - Country:US
Mailing Address - Phone:714-894-5029
Mailing Address - Fax:714-894-5087
Practice Address - Street 1:1258 NW EAGLE RIDGE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8248
Practice Address - Country:US
Practice Address - Phone:816-500-0643
Practice Address - Fax:888-877-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5061590001Medicare PIN