Provider Demographics
NPI:1568708816
Name:INNOVATIVE MEDICARE SOLUTIONS
Entity Type:Organization
Organization Name:INNOVATIVE MEDICARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-288-7260
Mailing Address - Street 1:4107 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76111-6860
Mailing Address - Country:US
Mailing Address - Phone:817-288-7260
Mailing Address - Fax:817-288-7262
Practice Address - Street 1:4107 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76111-6860
Practice Address - Country:US
Practice Address - Phone:817-288-7260
Practice Address - Fax:817-288-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency