Provider Demographics
NPI:1376879841
Name:ABBOTT INFUSION CARE LTD
Entity Type:Organization
Organization Name:ABBOTT INFUSION CARE LTD
Other - Org Name:ABBOTT INFUSION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:740-295-7010
Mailing Address - Street 1:PO BOX 1076
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812
Mailing Address - Country:US
Mailing Address - Phone:740-295-7010
Mailing Address - Fax:866-596-5061
Practice Address - Street 1:720 S 2ND ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1947
Practice Address - Country:US
Practice Address - Phone:740-295-7010
Practice Address - Fax:866-596-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 333600000X, 3336C0003X, 3336C0004X, 3336S0011X, 333600000X
OHPMY.021991050-033336H0001X
OH0219910503336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3013456Medicaid
2122627OtherPK
2122627OtherPK
OH3013456Medicaid
9386601Medicare PIN