Provider Demographics
NPI:1962650424
Name:INNOVATIVE MOBILE SERVICES LLC
Entity Type:Organization
Organization Name:INNOVATIVE MOBILE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-626-9729
Mailing Address - Street 1:PO BOX 2966
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2966
Mailing Address - Country:US
Mailing Address - Phone:417-626-9729
Mailing Address - Fax:
Practice Address - Street 1:1209 HEATHERVIEW DR
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-3914
Practice Address - Country:US
Practice Address - Phone:818-879-8037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE MOBILE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-08
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6638335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier