Healthcare Provider Details

I. General information

NPI: 1245403625
Provider Name (Legal Business Name): INNOVATIVE HEALTH NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10455 N CENTRAL EXPY STE 109
DALLAS TX
75231-2215
US

IV. Provider business mailing address

10455 N CENTRAL EXPY STE 109
DALLAS TX
75231-2215
US

V. Phone/Fax

Practice location:
  • Phone: 800-420-1481
  • Fax:
Mailing address:
  • Phone: 800-420-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE E BARKOCI
Title or Position: BILLING
Credential:
Phone: 817-625-9292