Provider Demographics
NPI:1417451709
Name:INNOVATIVE MEDICAL CENTERS, LLC
Entity Type:Organization
Organization Name:INNOVATIVE MEDICAL CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:ARDAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-436-9355
Mailing Address - Street 1:55 CAREN AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2515
Mailing Address - Country:US
Mailing Address - Phone:614-436-9355
Mailing Address - Fax:614-436-2052
Practice Address - Street 1:55 CAREN AVE STE 360
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2515
Practice Address - Country:US
Practice Address - Phone:614-436-9355
Practice Address - Fax:614-436-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
OHAPRN.CNP.019312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty