Provider Demographics
NPI:1730583030
Name:CS INNOVATIVE FITNESS
Entity type:Organization
Organization Name:CS INNOVATIVE FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:979-595-3080
Mailing Address - Street 1:3024 TEXAS AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845
Mailing Address - Country:US
Mailing Address - Phone:979-595-3080
Mailing Address - Fax:
Practice Address - Street 1:3024 TEXAS AVE SOUTH
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:979-595-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service