Provider Demographics
NPI:1467206110
Name:INNOVATIVE INFUSIONS, LLC
Entity Type:Organization
Organization Name:INNOVATIVE INFUSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-972-5888
Mailing Address - Street 1:3033 W PRESIDENT GEORGE BUSH HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5885
Mailing Address - Country:US
Mailing Address - Phone:972-588-1000
Mailing Address - Fax:
Practice Address - Street 1:4803 MONTGOMERY RD STE 100
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212-1153
Practice Address - Country:US
Practice Address - Phone:866-972-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE INFUSIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty