=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669105995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INOVI HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2022
-----------------------------------------------------
Last Update Date | 07/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4392 ROUND LAKE RD W
-----------------------------------------------------
City | ARDEN HILLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55112-3923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-321-5438
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4392 ROUND LAKE RD W
-----------------------------------------------------
City | ARDEN HILLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55112-3923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OPERATIONS
-----------------------------------------------------
Name | JACK DEMAREST
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-259-5268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------