Provider Demographics
NPI:1245403625
Name:INNOVATIVE HEALTH NETWORK, LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARKOCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-625-9292
Mailing Address - Street 1:10455 N CENTRAL EXPY STE 109
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2215
Mailing Address - Country:US
Mailing Address - Phone:800-420-1481
Mailing Address - Fax:
Practice Address - Street 1:10455 N CENTRAL EXPY STE 109
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2215
Practice Address - Country:US
Practice Address - Phone:800-420-1481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTID