Organization
INNOVATIVE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELOCHUKWU OSOEGO (OWNER)
(949) 696-6157
Entity
Organization
Contact information
Practice address
3218 W EDGEWOOD DR, STE 500, JEFFERSON CITY, MO 65109
(949) 696-6157
Mailing address
3218 W EDGEWOOD DR, STE 500, JEFFERSON CITY, MO 65109
(949) 696-6157
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
09/19/2023
Last updated
09/21/2023
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