Provider Demographics
NPI:1164845582
Name:OUTPATIENT INFUSION SYSTEMS, INC
Entity Type:Organization
Organization Name:OUTPATIENT INFUSION SYSTEMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-893-8457
Mailing Address - Street 1:800 TECHNOLOGY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4721
Mailing Address - Country:US
Mailing Address - Phone:972-506-9100
Mailing Address - Fax:972-506-0300
Practice Address - Street 1:8726 N ROYAL LN
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2589
Practice Address - Country:US
Practice Address - Phone:972-506-9100
Practice Address - Fax:972-506-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001211332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003194033AMedicaid
TX1001211OtherTEXAS DEVICE DISTRIBUTOR LICENSE