INNOVATIVE MEDICINE NPI 1417486523

NPI Information

  • NPI: 1417486523
  • Provider Name: INNOVATIVE MEDICINE
  • Classification: Family Medicine - 207QA0401X
  • Specialization: Addiction Medicine
  • Entity Type: Organization
  • Address: 3554 PROMENADE PKWY STE H
    LAFAYETTE, IN
    ZIP 47909
  • Phone: (765) 471-1100

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NPI Details

INNOVATIVE MEDICINE is an addiction medicine family medicine in Lafayette, IN. The provider is a family medicine physician who specializes in the diagnosis and treatment of addictions. INNOVATIVE MEDICINE NPI is 1417486523. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3554 PROMENADE PKWY STE H
LAFAYETTE, IN
ZIP 47909-418
Phone: (765) 471-1100
Fax: (765) 471-1009

The provider's authorized official is Jacqueline Snyder .
The authorized official title is Billing Manager and has the following contact phone number (765) 413-7100.

The enumeration date for this NPI number is 6/12/2017 and was last updated on 4/18/2024.

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
1207QA0401XFamily MedicineAddiction MedicineYes
2207QA0505XFamily MedicineAdult MedicineNo
3207QB0002XFamily MedicineObesity MedicineNo
4332900000XNon-Pharmacy Dispensing SiteNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11720219702OTHERINDIANAMELISSA GALBRETH LMHC
21144372863OTHERINDIANAROBERT CHARLES TURNER MD

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: 11/21/2025

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