Provider Demographics
NPI:1417084161
Name:OPTION CARE TROY, LLC
Entity Type:Organization
Organization Name:OPTION CARE TROY, LLC
Other - Org Name:ACTIVE INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FILIPPIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-829-8282
Mailing Address - Street 1:2845 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3661
Mailing Address - Country:US
Mailing Address - Phone:248-589-7755
Mailing Address - Fax:248-589-2644
Practice Address - Street 1:25219 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-4211
Practice Address - Country:US
Practice Address - Phone:248-589-7755
Practice Address - Fax:248-589-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4620050Medicaid
MI540F310380OtherBCBSM DME