Healthcare Provider Details

I. General information

NPI: 1467782789
Provider Name (Legal Business Name): INNOVATIVE HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DEE WELCH
Title or Position: BILLER
Credential:
Phone: 972-241-7738