Provider Demographics
NPI:1881881522
Name:INFUSAL PARTNERS
Entity type:Organization
Organization Name:INFUSAL PARTNERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, FIELD FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-855-6930
Mailing Address - Street 1:39280 TREASURY CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-9000
Mailing Address - Country:US
Mailing Address - Phone:904-861-2510
Mailing Address - Fax:904-861-2525
Practice Address - Street 1:9655 FLORIDA MINING BLVD W
Practice Address - Street 2:BLDG 400, SUITES 410-411
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2031
Practice Address - Country:US
Practice Address - Phone:904-861-2510
Practice Address - Fax:904-861-2525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFUSAL PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-26
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032386100Medicaid
FL032386100Medicaid