Provider Demographics
NPI:1225793565
Name:INNOVATIVE PHYSICIAN PARTNERS
Entity Type:Organization
Organization Name:INNOVATIVE PHYSICIAN PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:800-698-7142
Mailing Address - Street 1:1840 N COMMERCE PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3222
Mailing Address - Country:US
Mailing Address - Phone:800-698-7142
Mailing Address - Fax:833-216-5148
Practice Address - Street 1:1840 N COMMERCE PKWY STE 3
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3222
Practice Address - Country:US
Practice Address - Phone:800-698-7142
Practice Address - Fax:833-216-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management