Provider Demographics
NPI:1437272739
Name:INNOVATIVE R P INC
Entity Type:Organization
Organization Name:INNOVATIVE R P INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-218-7959
Mailing Address - Street 1:5535 MEMORIAL DR
Mailing Address - Street 2:STE F #325
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007
Mailing Address - Country:US
Mailing Address - Phone:713-218-7959
Mailing Address - Fax:
Practice Address - Street 1:5535 MEMORIAL DR
Practice Address - Street 2:STE F #325
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007
Practice Address - Country:US
Practice Address - Phone:713-218-7959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0094392332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000481OtherTEXAS DME LICENSE