Provider Demographics
NPI:1508157959
Name:INNOVATIVE SERVICES INC
Entity type:Organization
Organization Name:INNOVATIVE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-515-6719
Mailing Address - Street 1:7506 STATE ROUTE 5
Mailing Address - Street 2:PO BOX 325
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-3654
Mailing Address - Country:US
Mailing Address - Phone:315-853-1280
Mailing Address - Fax:315-853-6087
Practice Address - Street 1:6700 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13211-2141
Practice Address - Country:US
Practice Address - Phone:315-437-1627
Practice Address - Fax:315-437-7931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPSTATE NEWCO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-20
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6853OtherMEDICAID PIN
NY01818419Medicaid
NY023530OtherPHARMACY LICENSE
NY0701L004OtherDOH LICENSE NUMBER
NYTRMOtherMEDICAID ETIN
NY3336650OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NYTRMOtherMEDICAID ETIN
NY01818419Medicaid