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NPI Code Detail

MEDICARE: INNOVATIVE NEUROPHYSIOLOGICS LLC

MEDICARE: INNOVATIVE NEUROPHYSIOLOGICS LLC
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
1246ZS0410XSurgical Technologist

General Provider Information

NPI Number : 1699307264
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNOVATIVE NEUROPHYSIOLOGICS LLC
Provider Business Mailing Address
First Line : PO BOX 268977 DEPT 1071
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73126-8977
Country : US
Telephone Number : 918-895-7680
Fax Number : 918-236-4646
Provider Business Practice Location Address
First Line : 1715 S BALTIMORE AVE
Second Line :
City : TULSA
State : OK
Zip : 74119-4807
Country : US
Telephone Number : 918-895-7680
Fax Number : 918-236-4646
Authorized Official
Title or Position : BILLING ASSOCIATE
Name : VALERIE SHEHAN
Credential :
Telephone Number : 918-895-7680
Provider Enumeration Date : 02/11/2020
Last Update Date : 02/11/2020

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Directions to “INNOVATIVE NEUROPHYSIOLOGICS LLC ” Practice Location

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