Provider Demographics
NPI:1992767479
Name:IMPERIAL MEDICAL CORP
Entity type:Organization
Organization Name:IMPERIAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-878-8888
Mailing Address - Street 1:PO BOX 142931
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2931
Mailing Address - Country:US
Mailing Address - Phone:787-878-8888
Mailing Address - Fax:787-878-8888
Practice Address - Street 1:51 CALLE JUAN COLON PADILLA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00614-4412
Practice Address - Country:US
Practice Address - Phone:787-878-8888
Practice Address - Fax:787-878-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5164670001Medicare NSC