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
- 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
- Code Navigator
Location Map
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) |
|---|---|---|---|---|
| 1 | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | |
| 2 | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center |
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
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
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. | |||||||||
| 1 | 0 | 6 | 3 | 2 | 9 | 0 | 2 | 6 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 12 | 3 | 4 | 9 | 0 | 2 | 12 | |
| 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 |
|---|---|---|---|
| 1376598292 | JEFFERSON 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 Therapist | 3218 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].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.