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General NPI Number Information
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NPI Number | 1740683317
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Entity Type | Organization
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Legal Business Name | INNOVATECH MEDICAL RESOURCES, LP
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 5455 HONEYSUCKLE RD
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-7006
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Country | US
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Telephone | 972-938-3729
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Fax | 972-937-7555
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Provider Business Mailing Address
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Address Line | 5455 HONEYSUCKLE RD
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-7006
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Country | US
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Telephone | 972-938-3729
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Fax | 972-937-7555
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Authorized Official
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Title or Position | CFO
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Name | MS. KIM FULLER
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Credential |
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Telephone | 972-938-3729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1000097
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License Number State | TX
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