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NPI Code Detail

MEDICARE: INNOVATIVE MEDICAL SOLUTIONS INC

MEDICARE: INNOVATIVE MEDICAL SOLUTIONS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianM1979TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629254503
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNOVATIVE MEDICAL SOLUTIONS INC
Provider Business Mailing Address
First Line : PO BOX 802021
Second Line :
City : DALLAS
State : TX
Zip : 75380-2021
Country : US
Telephone Number : 972-770-2860
Fax Number :
Provider Business Practice Location Address
First Line : 8616 GREENVILLE AVE STE 100
Second Line :
City : DALLAS
State : TX
Zip : 75243-7166
Country : US
Telephone Number : 214-272-9710
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. QUAN NGUYEN
Credential : MD
Telephone Number : 972-897-4443
Provider Enumeration Date : 01/10/2008
Last Update Date : 03/20/2009

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Directions to “INNOVATIVE MEDICAL SOLUTIONS INC ” Practice Location

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