1770843302 NPI number — INNOVATIVE MEDICAL SOLUTIONS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770843302 NPI number — INNOVATIVE MEDICAL SOLUTIONS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE MEDICAL SOLUTIONS, PLLC
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:
1770843302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 COOL SPRINGS BLVD
Provider Second Line Business Mailing Address:
SUITE100
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-6474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-771-8552
Provider Business Mailing Address Fax Number:
615-771-8520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 COOL SPRINGS BLVD
Provider Second Line Business Practice Location Address:
SUITE100
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-6474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-771-8552
Provider Business Practice Location Address Fax Number:
615-771-8520
Provider Enumeration Date:
05/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MICELI
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
615-414-8459

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  MD31654 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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