Provider Demographics
NPI:1053553537
Name:INNOMEDISYS, LLC
Entity type:Organization
Organization Name:INNOMEDISYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERRYHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-288-0990
Mailing Address - Street 1:2608 ARTIE ST.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4791
Mailing Address - Country:US
Mailing Address - Phone:256-288-0990
Mailing Address - Fax:256-288-0960
Practice Address - Street 1:2608 ARTIE ST.
Practice Address - Street 2:SUITE 4
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4791
Practice Address - Country:US
Practice Address - Phone:256-288-0990
Practice Address - Fax:256-288-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL861332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6282110001Medicare NSC