Provider Demographics
NPI:1528673266
Name:INOVA HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:INOVA HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOEUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-377-3880
Mailing Address - Street 1:11207 SUNNY DELIGHT CT
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-6206
Mailing Address - Country:US
Mailing Address - Phone:239-500-4500
Mailing Address - Fax:
Practice Address - Street 1:4851 TAMIAMI TRL N STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3098
Practice Address - Country:US
Practice Address - Phone:239-500-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962667725Medicaid