1003944588 NPI number — INFUSION TECHNOLOGIES INC

Table of content: (NPI 1003944588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003944588 NPI number — INFUSION TECHNOLOGIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFUSION TECHNOLOGIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INFUSION TECHNOLOGIES, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003944588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 NE 126TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33161-4906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-887-9335
Provider Business Mailing Address Fax Number:
305-883-8869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3728 PHILLIPS HWY
Provider Second Line Business Practice Location Address:
STE. 212
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-9300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-399-3332
Provider Business Practice Location Address Fax Number:
904-399-3383
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOTOMAYOR
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-887-9335

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PH20070 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007702 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1012158610001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54010996 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02684450 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2610795 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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