Organization
IMI NEW MEXICO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVE SANDVOS (CFO)
(636) 530-0800
Entity
Organization
Contact information
Practice address
1 MCBRIDE AND SON CENTER DR, STE 150, CHESTERFIELD, MO 63005-1425
(636) 530-0800
(636) 519-4081
Mailing address
1 MCBRIDE AND SON CENTER DR, STE 150, CHESTERFIELD, MO 63005-1425
(636) 530-0800
(636) 519-4081
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87975734
—
NM
01
—
DB3026
RAILROAD MEDICARE
—
Enumeration date
04/06/2006
Last updated
02/22/2010
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