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General NPI Number Information
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NPI Number | 1881369510
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Entity Type | Organization
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Legal Business Name | INNOVATIVE MEDICINE LLC
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Dates
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Enumeration Date | 08/13/2021
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 850 E 9400 S STE 101
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City | SANDY
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State | UT
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Zip | 84094-4114
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Country | US
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Telephone | 385-449-0565
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Fax |
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Provider Business Mailing Address
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Address Line | 850 E 9400 S STE 101
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City | SANDY
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State | UT
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Zip | 84094-4114
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Country | US
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Telephone | 385-449-0565
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | WILLIAM BEESLEY
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Credential |
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Telephone | 385-449-0565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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