Provider Demographics
NPI:1023024635
Name:INFUSION SYSTEMS PC
Entity Type:Organization
Organization Name:INFUSION SYSTEMS PC
Other - Org Name:GENES PRESCRIPTION SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-629-4666
Mailing Address - Street 1:3890 TAMIAMI TRL
Mailing Address - Street 2:STE C
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8401
Mailing Address - Country:US
Mailing Address - Phone:941-629-7784
Mailing Address - Fax:941-627-4369
Practice Address - Street 1:3890 TAMIAMI TRL
Practice Address - Street 2:STE C
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8401
Practice Address - Country:US
Practice Address - Phone:941-629-7784
Practice Address - Fax:941-627-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH136543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1041540OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL104862700Medicaid
4552840001Medicare NSC