1124051180 NPI number — INFUCARE RX, LLC

Table of content: (NPI 1124051180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124051180 NPI number — INFUCARE RX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFUCARE RX, LLC
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:
HEALTH FIRST INFUSION
Provider Other Organization Name Type Code:
4
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:
1124051180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2578
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SECAUCUS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-828-3940
Provider Business Mailing Address Fax Number:
877-828-3941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1959 W 9TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-842-2828
Provider Business Practice Location Address Fax Number:
561-472-2280
Provider Enumeration Date:
07/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
DHARA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
877-828-3940

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PH12559 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PH12559 , 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: 015398200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104109600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1088055 . This is a "NCPDP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".