Provider Demographics
NPI:1780998963
Name:INNOVATIVE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:INNOVATIVE HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-447-2450
Mailing Address - Street 1:DEPT 960375
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1570 LINDBERG DR
Practice Address - Street 2:STE 12
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8058
Practice Address - Country:US
Practice Address - Phone:985-649-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE HEALTH SERVCIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-30
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207P00000X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1017621Medicaid
LADR4884OtherRAILROAD MEDICARE
LA1017621Medicaid