Imagine Medical International LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

IMAGINE MEDICAL INTERNATIONAL LLC

Doing business as

Imagine Medical International

Practice address

10151 Deerwood Park Blvd Ste 200-250
Jacksonville, FL 32256-0589

Phone

(904) 486-0746

NPI assigned

May 20, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Avanika Khanna Grover, DDS

Title

Chief Clinical Officer

Phone

(469) 323-9093

Specialties & licenses 1

Addresses

Other names 1

• Imagine Medical International Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621468800000",
    "number": "1932773256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10151 DEERWOOD PARK BLVD STE 200-250",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560589",
            "telephone_number": "904-486-0746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10151 DEERWOOD PARK BLVD STE 200-250",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560589",
            "telephone_number": "904-486-0746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE MEDICAL INTERNATIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A",
        "authorized_official_last_name": "GROVER",
        "authorized_official_first_name": "AVANIKA",
        "authorized_official_middle_name": "KHANNA",
        "authorized_official_title_or_position": "CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "469-323-9093",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Imagine Medical International",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.