Organization
IMPERIAL MEDICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HOWARD M WEISS (CEO)
(800) 700-9565
Entity
Organization
Contact information
Practice address
16666 E JOHNSON DR, SUITE # C, CITY OF INDUSTRY, CA 91745-2412
(800) 700-9565
(800) 450-3718
Mailing address
16666 EAST JOHNSON DR, SUITE # C, CITY OF INDUSTRY, CA 91745-2412
(800) 700-9565
(800) 450-3718
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
101028
CA
332BC3200X
Customized Equipment (DME)
101028
CA
332BN1400X
Nursing Facility Supplies (DME)
101028
CA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
101028
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DME02353F
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
07/13/2006
Last updated
09/24/2008
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