Healthcare Provider Details

I. General information

NPI: 1861093254
Provider Name (Legal Business Name): INNOVATIVE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 N HIGH ST STE 201
WORTHINGTON OH
43085-2316
US

IV. Provider business mailing address

7100 N HIGH ST STE 201
WORTHINGTON OH
43085-2316
US

V. Phone/Fax

Practice location:
  • Phone: 614-601-6272
  • Fax: 614-601-6291
Mailing address:
  • Phone: 614-638-8500
  • Fax: 614-601-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MORSE
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 614-638-8500