Provider Demographics
NPI:1699131870
Name:IMUA MEDICAL EQUIPMENT AND SUPPLIES,LLC
Entity type:Organization
Organization Name:IMUA MEDICAL EQUIPMENT AND SUPPLIES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH RAYMOND
Authorized Official - Middle Name:TANAEL
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-258-4015
Mailing Address - Street 1:1916 N KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3453
Mailing Address - Country:US
Mailing Address - Phone:808-853-2337
Mailing Address - Fax:808-845-2637
Practice Address - Street 1:1916 N KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3453
Practice Address - Country:US
Practice Address - Phone:808-853-2337
Practice Address - Fax:808-845-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies