Provider Demographics
NPI:1922096049
Name:INNOVATIVE PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:INNOVATIVE PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAHDUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-301-6019
Mailing Address - Street 1:95 FRANK B MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1106
Mailing Address - Country:US
Mailing Address - Phone:413-301-6019
Mailing Address - Fax:413-363-2857
Practice Address - Street 1:490 PAGE BOULEVARD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-349-5063
Practice Address - Fax:413-363-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110068493CMedicaid
NH30214102Medicaid
MAM18224OtherBLUE CROSS
MA9721690Medicaid
FL118236600Medicaid
DA5704Medicare PIN