Provider Demographics
NPI:1306846332
Name:AMBULATORY INFUSION CARE, INC.
Entity Type:Organization
Organization Name:AMBULATORY INFUSION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:989-773-4879
Mailing Address - Street 1:121 E. BROADWAY #C
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASASNT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-773-4879
Mailing Address - Fax:989-773-5233
Practice Address - Street 1:920 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-772-7770
Practice Address - Fax:989-772-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301005525332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2640581Medicaid
MIOC70260OtherBCBSM
MIOC70260OtherBCBM
MI2640581Medicaid