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
MR. 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) 853-1280
(315) 853-6087
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
333600000X
Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01818419
—
NY
01
—
023530
PHARMACY LICENSE
NY
01
—
0701L004
DOH LICENSE NUMBER
NY
01
—
3336650
NCPDP PROVIDER IDENTIFICATION NUMBER
NY
01
—
6853
MEDICAID PIN
NY
01
—
TRM
MEDICAID ETIN
NY
Enumeration date
04/20/2011
Last updated
05/16/2026
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