MEDICARE: INOVEON CORPORATION

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
1	293D00000X	Physiological Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	177946	OTHER	MO	BLUECROSS BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720085822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INOVEON CORPORATION

Provider Business Mailing Address
First Line	:	800 RESEARCH PARKWAY,
Second Line	:	SUITE 370,
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3611
Country	:	US
Telephone Number	:	405-271-9025
Fax Number	:	405-271-9026

Provider Business Practice Location Address
First Line	:	800 RESEARCH PARKWAY,
Second Line	:	SUITE 370,
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3611
Country	:	US
Telephone Number	:	405-271-9025
Fax Number	:	405-271-9026

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. G. CARL GIBSON
Credential	:	CPA
Telephone Number	:	405-271-9025

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/20/2012

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