Innovamed Veins SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036074111 Issued in IL

Legal business name

INNOVAMED VEINS SC

Practice address

2601 N Main St
Rockford, IL 61103-3110

Phone

(815) 987-1802

Fax

(815) 987-1806

NPI assigned

Mar 6, 2009

Last updated

Jun 4, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracy C Brito, M.D.

Title

Owner

Phone

(815) 987-1802

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244073600000",
    "number": "1063652873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 N MAIN ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033110",
            "telephone_number": "815-987-1802",
            "fax_number": "815-987-1806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 N MAIN ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033110",
            "telephone_number": "815-987-1802",
            "fax_number": "815-987-1806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVAMED VEINS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-06",
        "last_updated": "2009-06-04",
        "status": "A",
        "authorized_official_last_name": "BRITO",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-987-1802",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036074111",
            "primary": true
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "IL",
            "license": "036074111",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036074111",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Giovanni Incandela, DPM
• Tina Marie Ingram, LSW
• Theodore S. Ingrassia III, M.D.
• Melissa L. Inman, APN
• Innovamed Internal Medicine Specialists SC
• Institute of Family Care
• Institute of Family Care
• Integrated Health, SC
• Integrated Homecare Services
• Integrated Homecare Services, Inc.

• Internal Medicine Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.