Healthcare Provider Details

I. General information

NPI: 1053039032
Provider Name (Legal Business Name): INNOVIS HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 9TH ST
BISMARCK ND
58501-4530
US

IV. Provider business mailing address

1702 UNIVERSITY DR S ATN: MED STAFF SERVICES-SSC
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 701-712-4500
  • Fax:
Mailing address:
  • Phone:
  • 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 HURLEY
Title or Position: COO
Credential:
Phone: 701-364-7667