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General NPI Number Information
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NPI Number | 1821266586
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Entity Type | Organization
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Legal Business Name | INNOVATIVE CLINICAL SOLUTIONS
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 216 E. BLANCO RD. STE. 101
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City | BOERNE
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State | TX
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Zip | 78006
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Country | US
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Telephone | 830-816-5131
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Fax | 830-816-5133
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Provider Business Mailing Address
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Address Line | P.O. BOX 1259
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City | BOERNE
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State | TX
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Zip | 78006
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Country | US
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Telephone | 830-816-5131
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Fax | 830-816-5133
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Authorized Official
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Title or Position | CEO
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Name | BARRON H. CHEEK II
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Credential |
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Telephone | 210-241-2140
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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 | 0100097
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0100097DME
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License Number State | TX
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