Provider Demographics
NPI:1306816004
Name:PLATINUM INNOVATIONS LTD
Entity Type:Organization
Organization Name:PLATINUM INNOVATIONS LTD
Other - Org Name:SOLE SUPPORT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-615-0004
Mailing Address - Street 1:7400 LOUIS PASTEUR DR
Mailing Address - Street 2:STE. 112
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4510
Mailing Address - Country:US
Mailing Address - Phone:210-615-0004
Mailing Address - Fax:210-615-0007
Practice Address - Street 1:7400 LOUIS PASTEUR DR
Practice Address - Street 2:STE. 112
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4514
Practice Address - Country:US
Practice Address - Phone:210-615-0004
Practice Address - Fax:210-615-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159805401Medicaid
LA1455211Medicaid
TX0000531702OtherBLUE CROSS
LA1623890Medicaid
AZ830027Medicaid
NM10300040Medicaid
NM10300040Medicaid
LA1455211Medicaid