Provider Demographics
NPI:1376964957
Name:INNOVATIVE HEALTHCARE OF MID MISSOURI INC.
Entity Type:Organization
Organization Name:INNOVATIVE HEALTHCARE OF MID MISSOURI INC.
Other - Org Name:BRIGHTSTAR OF MID-MISSOURI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT / PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-814-9230
Mailing Address - Street 1:108 E GREEN MEADOWS RD
Mailing Address - Street 2:STE 8
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-3633
Mailing Address - Country:US
Mailing Address - Phone:573-814-9230
Mailing Address - Fax:
Practice Address - Street 1:108 E GREEN MEADOWS RD
Practice Address - Street 2:STE 8
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3633
Practice Address - Country:US
Practice Address - Phone:573-814-9230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health