1790229649 NPI number — INFUSION CENTERS OF FLORIDA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790229649 NPI number — INFUSION CENTERS OF FLORIDA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFUSION CENTERS OF FLORIDA, 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:
INFUSION CENTERS OF FLORIDA, CORP.
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:
1790229649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32789
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33420-2789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-327-4970
Provider Business Mailing Address Fax Number:
561-823-0829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2751 EXECUTIVE PARK DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33331-3660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-603-9824
Provider Business Practice Location Address Fax Number:
305-383-7408
Provider Enumeration Date:
12/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SHELTON
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official Telephone Number:
513-313-9014

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QI0500X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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