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General NPI Number Information
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NPI Number | 1396383105
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Entity Type | Organization
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Legal Business Name | INNOVATIVE MEDICAL LLC
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 4130 E SUNSET RD
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City | HENDERSON
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State | NV
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Zip | 89014-0212
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Country | US
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Telephone | 702-670-0397
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Fax | 702-726-9531
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Provider Business Mailing Address
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Address Line | 209 S STEPHANIE ST # B146
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City | HENDERSON
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State | NV
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Zip | 89012-5501
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Country | US
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Telephone | 702-884-6292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN RAMSEY
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Credential | MD
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Telephone | 702-884-6292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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