Provider Demographics
NPI:1386395143
Name:INTERVENTIONAL MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:INTERVENTIONAL MEDICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-351-3413
Mailing Address - Street 1:1009 SW 16TH LANE SUITE B
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1228
Mailing Address - Country:US
Mailing Address - Phone:352-351-3413
Mailing Address - Fax:352-629-6667
Practice Address - Street 1:1009 SW 16TH LANE SUITE B
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1228
Practice Address - Country:US
Practice Address - Phone:352-351-3413
Practice Address - Fax:352-629-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Single Specialty