# ACOUSTIC WAVE TREATMENT CENTER OF MS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Innovative Health Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245904150
- **Authorized official:** STACEY L HOLT (CEO)
- **Authorized official phone:** (601) 944-5585

## Contact information

- **Practice address:** 230 TRACE COLONY PARK DR STE 1, RIDGELAND, MS 39157-8851
- **Practice address phone:** (601) 944-5585
- **Mailing address:** 230 TRACE COLONY PARK DR STE 1, RIDGELAND, MS 39157-8851
- **Mailing address phone:** (601) 944-5585

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/04/2021
- **Last updated:** 09/23/2022