Organization
INNOVATIVE SERVICES INC
Active
Parent organization
UPSTATE NEWCO LLC
Other names
LUX Infusion 9, UPSTATE HOMECARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
UPSTATE NEWCO LLC
Authorized official
EDWARD P KRAMM (CHIEF EXECUTIVE OFFICER)
(913) 515-6719
Entity
Organization
Contact information
Practice address
6700 THOMPSON RD, SYRACUSE, NY 13211-2141
(315) 437-1627
(315) 437-7931
Mailing address
PO BOX 931769, ATLANTA, GA 31193-1769
(315) 437-1627
(315) 437-7931
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
023530
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01818419
—
NY
01
—
023530
PHARMACY LICENSE
NY
01
—
0701L004
DOH LIC#
NY
01
—
3336650
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
6853
MCD PIN
NY
01
—
TRM
MCD ETIN
NY
Enumeration date
05/25/2006
Last updated
04/21/2026
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