Provider Demographics
NPI:1366412249
Name:INNOVATIVE TECHNOLOGIES, INC.
Entity type:Organization
Organization Name:INNOVATIVE TECHNOLOGIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-499-4899
Mailing Address - Street 1:PO BOX 562
Mailing Address - Street 2:3217 WEST M 55
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-0562
Mailing Address - Country:US
Mailing Address - Phone:989-345-7764
Mailing Address - Fax:989-345-4564
Practice Address - Street 1:3217 W M 55
Practice Address - Street 2:STE G
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9179
Practice Address - Country:US
Practice Address - Phone:989-345-7764
Practice Address - Fax:989-345-4564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE TECHNOLOGIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-24
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB ME 0148640332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540F502640OtherBLUE CROSS BLUE SHIELD
MI3244940Medicare ID - Type Unspecified
MI540F502640OtherBLUE CROSS BLUE SHIELD