Provider Demographics
NPI:1205526837
Name:INNOVATION MEDICAL PLLC
Entity type:Organization
Organization Name:INNOVATION MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRICK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:520-780-2533
Mailing Address - Street 1:5335 W AVENIDA TIERRA ALTA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-4194
Mailing Address - Country:US
Mailing Address - Phone:520-780-2533
Mailing Address - Fax:
Practice Address - Street 1:6450 N SWAN RD STE 120
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-3656
Practice Address - Country:US
Practice Address - Phone:520-260-1181
Practice Address - Fax:520-366-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care