Acoustic Wave Treatment Center of Ms LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ACOUSTIC WAVE TREATMENT CENTER OF MS LLC

Doing business as

Innovative Health Clinic

Practice address

230 Trace Colony Park Dr Ste 1
Ridgeland, MS 39157-8851

Phone

(601) 944-5585

NPI assigned

Aug 4, 2021

Last updated

Sep 23, 2022By 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

Stacey L Holt

Title

Ceo

Phone

(601) 944-5585

Specialties & licenses 1

Addresses

Other names 1

• Innovative Health Clinic Doing business as

Locations

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

{
    "created_epoch": "1628035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663891200000",
    "number": "1245904150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 TRACE COLONY PARK DR STE 1",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391578851",
            "telephone_number": "601-944-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 TRACE COLONY PARK DR STE 1",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391578851",
            "telephone_number": "601-944-5585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACOUSTIC WAVE TREATMENT CENTER OF MS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-04",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A",
        "authorized_official_last_name": "HOLT",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-944-5585"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Innovative Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; 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.