Healthcare Provider Details

I. General information

NPI: 1114361177
Provider Name (Legal Business Name): INNOVIS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 9TH AVE N
CASSELTON ND
58012-3339
US

IV. Provider business mailing address

PO BOX 1450 NW7813
MINNEAPOLIS MN
55485-7813
US

V. Phone/Fax

Practice location:
  • Phone: 701-347-4445
  • Fax: 701-347-5276
Mailing address:
  • Phone: 701-364-3300
  • Fax: 701-364-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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