Provider Demographics
NPI:1114781408
Name:NFINITY INNOVATIVE SOLUTIONS LLC
Entity Type:Organization
Organization Name:NFINITY INNOVATIVE SOLUTIONS LLC
Other - Org Name:NFINITY INNOVATIVE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-244-2430
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:PRENTISS
Mailing Address - State:MS
Mailing Address - Zip Code:39474-0177
Mailing Address - Country:US
Mailing Address - Phone:844-244-2430
Mailing Address - Fax:844-244-2430
Practice Address - Street 1:1814 COLUMBIA AVE STE B
Practice Address - Street 2:
Practice Address - City:PRENTISS
Practice Address - State:MS
Practice Address - Zip Code:39474-5002
Practice Address - Country:US
Practice Address - Phone:844-244-2430
Practice Address - Fax:844-244-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty