Provider Demographics
NPI:1023223633
Name:INNOVATIVE HEALTH CONCEPTS
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:260-413-2958
Mailing Address - Street 1:9410 STOCKBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-2719
Mailing Address - Country:US
Mailing Address - Phone:260-413-2958
Mailing Address - Fax:
Practice Address - Street 1:1201 DALY DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-1891
Practice Address - Country:US
Practice Address - Phone:260-413-2958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN226410Medicare ID - Type Unspecified