Provider Demographics
NPI:1013534049
Name:INNOVATIVE MEDICAL SOLUTIONS, INC.
Entity Type:Organization
Organization Name:INNOVATIVE MEDICAL SOLUTIONS, INC.
Other - Org Name:DYNAMIC MEDICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICKI
Authorized Official - Middle Name:J
Authorized Official - Last Name:THEODORIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-753-5459
Mailing Address - Street 1:3860 N MULBERRY DR APT 5310
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-1894
Mailing Address - Country:US
Mailing Address - Phone:816-753-5459
Mailing Address - Fax:
Practice Address - Street 1:4218 ROANOKE RD STE 304
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-4996
Practice Address - Country:US
Practice Address - Phone:816-753-5459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty