INNOVATIVE MEDICAL CLINIC
NPI 1063290260
Clinic/Center - Multi-Specialty in Jefferson City, MO

NPI Status: Active since September 19, 2023

Contact Information

3218 W EDGEWOOD DR
STE 500
JEFFERSON CITY, MO
ZIP 65109
Phone: (949) 696-6157

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  • Organization
  • Clinic/Center
  • Multi-Specialty
  • CLIA Number: 26D2237720
  • CLIA Cert. Type: Practitioner Other
  • CLIA Exp. Date: 09-27-2025

About INNOVATIVE MEDICAL CLINIC

This page provides the complete NPI Profile along with additional information for Innovative Medical Clinic, a provider established in Jefferson City, Missouri operating as a Clinic/center, focusing in multi-specialty . The healthcare provider is registered in the NPI registry with number 1063290260 assigned on September 2023. The practitioner's primary taxonomy code is 261QM1300X. The provider is registered as an organization and their NPI record was last updated 2 years ago. The authorized official of this NPI record is Elochukwu Osoego (Owner)

NPI
1063290260
Provider Name
INNOVATIVE MEDICAL CLINIC
Entity Type
Organization
Location Address
3218 W EDGEWOOD DR STE 500 JEFFERSON CITY, MO 65109
Location Phone
(949) 696-6157
Mailing Address
3218 W EDGEWOOD DR STE 500 JEFFERSON CITY, MO 65109
Mailing Phone
(949) 696-6157
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
09-19-2023
Last Update Date
09-21-2023
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center Multi-Specialty

Taxonomy Code
261QM1300X
Type
Ambulatory Health Care Facilities

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1261QP2300XAmbulatory Health Care Facilities

Clinic/Center
Primary Care

 
2261QU0200XAmbulatory Health Care Facilities

Clinic/Center
Urgent Care

 

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

ELOCHUKWU OSOEGO

Authorized Official Title
OWNER
Authorized Official Phone
(949) 696-6157

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
26D2237720
Facility Type
Practitioner Other
Certificate Effective Date
September 28, 2023
Certificate Expiration Date
September 27, 2025
Laboratory Director
ELOCHUKWU A. OSOEGO
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Innovative Medical Clinic to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Reviews for INNOVATIVE MEDICAL CLINIC

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1063290260
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20123490212
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 1 + 2 + 3 + 4 + 9 + 0 + 2 + 1 + 2 + 24 = 50
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
0

The NPI number 1063290260 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1376598292JEFFERSON CITY OPEN MRI LLC
Organization
Clinic/Center (Radiology)3218 W EDGEWOOD DR SUITE 200
JEFFERSON CITY, MO 65109
(573) 635-6262
1700284296 ABAGAEL RICHARDS HUNT PT
Individual
Physical Therapist3218 W EDGEWOOD DR
JEFFERSON CITY, MO 65109
(573) 634-3815

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1063290260, enumerated in the NPI registry as an "organization" on September 19, 2023

The provider is located at 3218 W Edgewood Dr Ste 500 Jefferson City, Mo 65109 and the phone number is (949) 696-6157

This medical organization specializes in Clinic/Center with taxonomy code 261QM1300X with a focus in Multi-Specialty

The provider's CLIA number is 26D2237720 for a "practitioner other" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..

This NPI record was last updated on September 19, 2023. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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