Provider Demographics
NPI:1225387699
Name:INFUSION SOLUTIONS OF PUERTO RICO, LLC
Entity Type:Organization
Organization Name:INFUSION SOLUTIONS OF PUERTO RICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-315-3395
Mailing Address - Street 1:108 CARR 2 STE 301
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1830
Mailing Address - Country:US
Mailing Address - Phone:787-780-7200
Mailing Address - Fax:787-779-1430
Practice Address - Street 1:108 CARR 2 STE 301
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1830
Practice Address - Country:US
Practice Address - Phone:787-780-7200
Practice Address - Fax:787-779-1430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FARMACIA DORAL, INC. DBA AXIUM HEALTHCARE DE PUERTO RICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy