Provider Demographics
NPI:1336279462
Name:INNOVATIVE PROGRAMMING ASSOCIATES, INC.
Entity Type:Organization
Organization Name:INNOVATIVE PROGRAMMING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-0734
Mailing Address - Street 1:111 LAMON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4957
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1023 HIGHWAY 17 S
Practice Address - Street 2:SUITE 1
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9070
Practice Address - Country:US
Practice Address - Phone:910-483-0734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900982Medicaid