MEDICARE: INNOVATIVE CARE ELEMENTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1285010272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE CARE ELEMENTS LLC

Provider Business Mailing Address
First Line	:	PO BOX 3276
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47731-3276
Country	:	US
Telephone Number	:	812-473-0181
Fax Number	:	812-473-5822

Provider Business Practice Location Address
First Line	:	1325 W WHITTAKER ST
Second Line	:	SUITE 3
City	:	SALEM
State	:	IL
Zip	:	62881-2007
Country	:	US
Telephone Number	:	618-548-2400
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS DIRECTOR
Name	:	STEVEN N SCOTT
Credential	:	M.D.
Telephone Number	:	618-842-2491

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	03/30/2016

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