Healthcare Provider Details

I. General information

NPI: 1548706476
Provider Name (Legal Business Name): INNOVATIVE LABORATORYSERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2654 SW 32ND PL SUITE 200
OCALA FL
34471-7847
US

IV. Provider business mailing address

713 E MARION AVE SUITE 1211
PUNTA GORDA FL
33950-3872
US

V. Phone/Fax

Practice location:
  • Phone: 941-505-1000
  • Fax: 941-505-6100
Mailing address:
  • Phone: 941-505-2100
  • Fax: 941-505-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH RAVID
Title or Position: PRESIDENT AND OWNER
Credential: MD
Phone: 941-505-2100