Provider Demographics
NPI:1295968071
Name:INNOVATIVE NEUROTRONICS, INC
Entity type:Organization
Organization Name:INNOVATIVE NEUROTRONICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-721-1900
Mailing Address - Street 1:3600 N CAPITAL OF TEXAS HWY
Mailing Address - Street 2:BLDG B SUITE 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-3314
Mailing Address - Country:US
Mailing Address - Phone:512-721-1900
Mailing Address - Fax:512-721-1970
Practice Address - Street 1:3600 N CAPITAL OF TEXAS HWY
Practice Address - Street 2:BLDG B SUITE 150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-3314
Practice Address - Country:US
Practice Address - Phone:512-721-1900
Practice Address - Fax:512-721-1970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER ORTHOPEDIC GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6385050001Medicare NSC