Provider Demographics
NPI:1568504165
Name:IMARS MEDICAL SUPPLY
Entity type:Organization
Organization Name:IMARS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:EZENWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-750-8815
Mailing Address - Street 1:8225 S NORMANDIE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2335
Mailing Address - Country:US
Mailing Address - Phone:323-750-8815
Mailing Address - Fax:323-750-8818
Practice Address - Street 1:8225 S NORMANDIE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2335
Practice Address - Country:US
Practice Address - Phone:323-750-8815
Practice Address - Fax:323-750-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103186332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies