Provider Demographics
NPI:1093160566
Name:INFUSERV CORPORATION
Entity Type:Organization
Organization Name:INFUSERV CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CFO
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKEFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-368-5555
Mailing Address - Street 1:601 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4564
Mailing Address - Country:US
Mailing Address - Phone:540-368-5555
Mailing Address - Fax:540-368-5557
Practice Address - Street 1:601 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4564
Practice Address - Country:US
Practice Address - Phone:540-368-5555
Practice Address - Fax:540-368-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QI0500X
GAPHRE0100443336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1548629447Medicaid
0268060001Medicare PIN