Provider Demographics
NPI:1104476993
Name:RENEW INFUSIONS
Entity type:Organization
Organization Name:RENEW INFUSIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-630-1733
Mailing Address - Street 1:4001 E BASELINE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2736
Mailing Address - Country:US
Mailing Address - Phone:480-630-1733
Mailing Address - Fax:480-304-3297
Practice Address - Street 1:4001 E BASELINE RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2736
Practice Address - Country:US
Practice Address - Phone:480-630-1733
Practice Address - Fax:480-304-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy