1386851442 NPI number — INNOVATIVE WORK SOLUTIONS, LLC

Table of content: (NPI 1386851442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386851442 NPI number — INNOVATIVE WORK SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE WORK SOLUTIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386851442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 WEST 39TH STREET
Provider Second Line Business Mailing Address:
ROOM 201
Provider Business Mailing Address City Name:
SHADYSIDE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-671-3188
Provider Business Mailing Address Fax Number:
740-671-3187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 WEST 39TH STREET
Provider Second Line Business Practice Location Address:
ROOM 201
Provider Business Practice Location Address City Name:
SHADYSIDE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-671-3188
Provider Business Practice Location Address Fax Number:
740-671-3187
Provider Enumeration Date:
05/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BASICH
Authorized Official First Name:
MARK
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-671-3188

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0800577 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 0800577 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 550777912-00 . This is a "OHIO BUREAU WORKERS COMP" identifier . This identifiers is of the category "OTHER".