Provider Demographics
NPI:1417456633
Name:PATIENT CARE INFUSION LLC
Entity Type:Organization
Organization Name:PATIENT CARE INFUSION LLC
Other - Org Name:ARIZONA HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-246-3968
Mailing Address - Street 1:1626 S EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6200
Mailing Address - Country:US
Mailing Address - Phone:480-246-3968
Mailing Address - Fax:602-323-5070
Practice Address - Street 1:1626 S EDWARD DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6200
Practice Address - Country:US
Practice Address - Phone:480-246-3968
Practice Address - Fax:602-323-5070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATIENT CARE INFUSION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0026671835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ312512-01Medicaid