Provider Demographics
NPI:1306279963
Name:IMS MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:IMS MEDICAL SUPPLY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHANBASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-519-8314
Mailing Address - Street 1:8400 LINCOLN BLVD # B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2416
Mailing Address - Country:US
Mailing Address - Phone:888-519-8314
Mailing Address - Fax:
Practice Address - Street 1:8400 LINCOLN BLVD # B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2416
Practice Address - Country:US
Practice Address - Phone:888-519-8314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies