Provider Demographics
NPI:1558416636
Name:INNOVATION MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:INNOVATION MEDICAL SUPPLIES INC.
Other - Org Name:IMS EMERGENCY MEDICAL PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:UCHENNA
Authorized Official - Last Name:ONUOHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-771-5010
Mailing Address - Street 1:9894 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1350
Mailing Address - Country:US
Mailing Address - Phone:713-771-5010
Mailing Address - Fax:713-771-5081
Practice Address - Street 1:9894 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1350
Practice Address - Country:US
Practice Address - Phone:713-771-5010
Practice Address - Fax:713-771-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0083327332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182307202Medicaid
TX182307201Medicaid
TX182307201Medicaid