1144588278 NPI number — INFINITY COMPOUNDING SOLUTIONS LLC

Table of content: (NPI 1144588278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144588278 NPI number — INFINITY COMPOUNDING SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITY COMPOUNDING SOLUTIONS 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:
Provider Other Organization Name Type Code:
6
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:
1144588278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTONVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72712-0699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-250-1443
Provider Business Mailing Address Fax Number:
479-268-3478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1204 SE 28TH ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712-3887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-250-1443
Provider Business Practice Location Address Fax Number:
479-268-3478
Provider Enumeration Date:
04/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WHITEHEAD
Authorized Official First Name:
TALMAGE
Authorized Official Middle Name:
JEREMY
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
870-347-2534

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; 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: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 158837861 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144588278 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144588278 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144588278 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2136279 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61049 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100416640 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026562900 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144588278 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144588278 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144588278 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144588278 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196379407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2071647 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26120054 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7580070 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144588278 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144588278 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 568848 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144588278 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com