Healthcare Provider Details

I. General information

NPI: 1164978599
Provider Name (Legal Business Name): INNOVIS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 WENNER RD
DETROIT LAKES MN
56501-7918
US

IV. Provider business mailing address

PO BOX 1450 NW7813
MINNEAPOLIS MN
55485-7813
US

V. Phone/Fax

Practice location:
  • Phone: 218-846-9981
  • Fax:
Mailing address:
  • Phone: 701-364-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAN J HURLEY
Title or Position: COO
Credential:
Phone: 701-364-7667