| Organization Name: | INNOVATIVE MEDICAL SUPPLY, LLC |
| NPI Number: | 1679570121 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN K BERRY (MEMBER) |
| Mailing Address: | 1501 Se 4th St Suite D Moore |
| State: | OK US |
| Postal Code: | 731608231 |
| Phone Number: | 4057998855 |
| Fax Number: | 4057998860 |
| NPI Enumeration Date: | 06/30/2005 |
| NPI Last Update Date: | 10/18/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |