Basic Information
| Provider Information | |||||||||
| NPI: | 1427298330 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE HOSPITAL CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7950 W JEFFERSON BLVD STE 2121 | ||||||||
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| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468044140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604357937 | ||||||||
| FaxNumber: | 2604357933 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 W 12TH ST | ||||||||
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| City: | PERU | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469701638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654728000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2009 | ||||||||
| LastUpdateDate: | 05/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | HOUSE | ||||||||
| AuthorizedOfficialFirstName: | BEVE | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2604357937 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.