Healthcare Provider Details

I. General information

NPI: 1447848163
Provider Name (Legal Business Name): INNOVATIVE INJURY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18511 N SCOTTSDALE RD STE 202
SCOTTSDALE AZ
85255-9694
US

IV. Provider business mailing address

18511 N SCOTTSDALE RD STE 202
SCOTTSDALE AZ
85255-9694
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-7242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRANT COOK
Title or Position: MANAGER
Credential:
Phone: 480-306-7242