INNOVATIVE MEDICAL CLINIC NPI 1063290260

NPI Information

  • NPI: 1063290260
  • Provider Name: INNOVATIVE MEDICAL CLINIC
  • Classification: Clinic/Center - 261QM1300X
  • Specialization: Multi-Specialty
  • Entity Type: Organization
  • CLIA Number: 26D2237720
  • Address: 3218 W EDGEWOOD DR
    STE 500
    JEFFERSON CITY, MO
    ZIP 65109
  • Phone: (949) 696-6157

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NPI Details

INNOVATIVE MEDICAL CLINIC is a multi-specialty clinic center in Jefferson City, MO. INNOVATIVE MEDICAL CLINIC NPI is 1063290260. The provider is registered as an organization entity type.

The provider's business location address is:

3218 W EDGEWOOD DR
STE 500
JEFFERSON CITY, MO
ZIP 65109
Phone: (949) 696-6157

The provider's authorized official is Elochukwu Osoego .
The authorized official title is Owner and has the following contact phone number (949) 696-6157.

The CLIA number assigned to this NPI record is 26D2237720 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/19/2023 and was last updated on 9/21/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareNo
2261QU0200XClinic/CenterUrgent CareNo
3261QM1300XClinic/CenterMulti-SpecialtyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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