1851567812 NPI number — INNOVATIVE SERVICES INC

Table of content: (NPI 1851567812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851567812 NPI number — INNOVATIVE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE SERVICES INC
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:
6
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:
1851567812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 325
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13323-0325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
131-585-3128
Provider Business Mailing Address Fax Number:
315-853-6087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 AIRPARK DR
Provider Second Line Business Practice Location Address:
SUITE 90
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14624-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-328-2050
Provider Business Practice Location Address Fax Number:
585-328-2058
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CROSSMAN
Authorized Official First Name:
ALYCE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VP, CIO
Authorized Official Telephone Number:
13158531280

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3358771 . This is a "NCPDP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 28984 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0701L003 . This is a "DOH LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com