# INNOVASIS NEUROLOGICAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659669919
- **Authorized official:** KELLY DOUCET (BILLING DEPARTMENT)
- **Authorized official phone:** (281) 462-1285

## Contact information

- **Practice address:** 614 E 3900 S, SALT LAKE CITY, UT 84107-1902
- **Practice address phone:** (281) 462-1285
- **Practice address fax:** (281) 462-1554
- **Mailing address:** 614 E 3900 S, SALT LAKE CITY, UT 84107-1902

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246Z00000X | Other Specialist/Technologist | — | NULL | Yes |
| 246Z00000X | Other Specialist/Technologist | — | — | Yes |

## Other

- **Enumeration date:** 07/20/2011
- **Last updated:** 07/20/2011