Provider Demographics
NPI:1629254503
Name:INNOVATIVE MEDICAL SOLUTIONS INC
Entity Type:Organization
Organization Name:INNOVATIVE MEDICAL SOLUTIONS INC
Other - Org Name:ADVANCED HEMORRHOID SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:QUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-897-4443
Mailing Address - Street 1:PO BOX 802021
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-2021
Mailing Address - Country:US
Mailing Address - Phone:972-770-2860
Mailing Address - Fax:
Practice Address - Street 1:8616 GREENVILLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7166
Practice Address - Country:US
Practice Address - Phone:214-272-9710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1979208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z401Medicaid