1780869982 NPI number — INFINITY HEALTH SERVICES, INC.

Table of content: (NPI 1780869982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780869982 NPI number — INFINITY HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITY HEALTH SERVICES, 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:
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:
1780869982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1165 NORTHCHASE PKWY SE STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30067-6432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-421-0191
Provider Business Mailing Address Fax Number:
561-207-7843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 CORPORATE DR STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33426-6654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-819-0460
Provider Business Practice Location Address Fax Number:
561-207-7843
Provider Enumeration Date:
01/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LYNCH
Authorized Official First Name:
MARCELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP OF COMPLIANCE
Authorized Official Telephone Number:
470-392-9412

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299993383 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com