Provider Demographics
NPI:1285010272
Name:INNOVATIVE CARE ELEMENTS LLC
Entity Type:Organization
Organization Name:INNOVATIVE CARE ELEMENTS LLC
Other - Org Name:INNOVATIVE CARE EXPRESS SERIES 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-842-2491
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:1325 W WHITTAKER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2007
Practice Address - Country:US
Practice Address - Phone:618-548-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE CARE ELEMENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-03
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty