Provider Demographics
NPI:1013294537
Name:INNOVATIVE CORPORATE SOLUTIONS, INC.
Entity Type:Organization
Organization Name:INNOVATIVE CORPORATE SOLUTIONS, INC.
Other - Org Name:CLOVER MEDICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:941-779-5944
Mailing Address - Street 1:63 SARASOTA CENTER BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9385
Mailing Address - Country:US
Mailing Address - Phone:941-342-1646
Mailing Address - Fax:
Practice Address - Street 1:63 SARASOTA CENTER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9385
Practice Address - Country:US
Practice Address - Phone:941-342-1646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ROOF8OtherBCBS PROVIDER NUMBER
6709280001Medicare NSC