Provider Demographics
NPI:1821266586
Name:INNOVATIVE CLINICAL SOLUTIONS
Entity Type:Organization
Organization Name:INNOVATIVE CLINICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARRON
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHEEK
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:210-241-2140
Mailing Address - Street 1:P.O. BOX 1259
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:830-816-5131
Mailing Address - Fax:830-816-5133
Practice Address - Street 1:216 E. BLANCO RD.
Practice Address - Street 2:STE. 101
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-816-5131
Practice Address - Fax:830-816-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0100097332B00000X
TX0100097DME332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies