Organization
IMPUNITUS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD JEROME SLOVACEK (MEMBER)
(979) 846-4667
Entity
Organization
Contact information
Practice address
414A TARROW ST, COLLEGE STATION, TX 77840-7811
(979) 846-4667
(866) 703-2713
Mailing address
PO BOX 5294, BRYAN, TX 77805-5294
(979) 846-4667
(866) 703-2713
Taxonomy
Speciality
Code
Description
License number
State
163WC2100X
Continence Care Registered Nurse
Primary
—
—
163WW0000X
Wound Care Registered Nurse
—
—
163WX1500X
Ostomy Care Registered Nurse
—
—
Other
Enumeration date
05/01/2009
Last updated
05/01/2009
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