Provider Demographics
NPI:1942571005
Name:INNOVATIVE HEALTHCARE SOLUTIONS LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTHCARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLAYBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-500-9563
Mailing Address - Street 1:3016 KINGSTON CIR N
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8441
Mailing Address - Country:US
Mailing Address - Phone:615-500-9563
Mailing Address - Fax:
Practice Address - Street 1:901 12TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4705
Practice Address - Country:US
Practice Address - Phone:615-254-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-21
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty