Provider Demographics
NPI:1598938607
Name:INNOVATIVE HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH SOLUTIONS LLC
Other - Org Name:INNOVATIVE HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:O
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-916-6749
Mailing Address - Street 1:1018 SIXTH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3837
Mailing Address - Country:US
Mailing Address - Phone:601-799-4044
Mailing Address - Fax:601-799-4045
Practice Address - Street 1:1018 SIXTH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3837
Practice Address - Country:US
Practice Address - Phone:601-799-4044
Practice Address - Fax:601-799-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR876364363LF0000X
MSR868356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty