OrganizationActive
Innovative Medical Clinic
NPI 1063290260 · Multi-Specialty Clinic/Center · Jefferson City, MO
Provider details
- NPI number
- 1063290260
- Entity type
- Organization
- Primary specialty
- Multi-Specialty Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Elochukwu Osoego, Owner(949) 696-6157
Specialties & taxonomies
Ambulatory Health Care Facilities
- Primary Care Clinic/Center261QP2300X
Ambulatory Health Care Facilities
- Urgent Care Clinic/Center261QU0200X
Ambulatory Health Care Facilities
Practice location
3218 W Edgewood Dr
Ste 500
Jefferson City, MO 65109
Phone: (949) 696-6157
Approximate (ZIP-level) locationGet directions
Mailing address
3218 W Edgewood Dr
Jefferson City, MO 65109
Registry dates
- Enumerated
- 2023-09-19
- Last updated
- 2023-09-21
- Certified
- 2023-09-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.