Provider Demographics
NPI:1447200159
Name:AMBULATORY INFUSION CARE NORTH, INC
Entity Type:Organization
Organization Name:AMBULATORY INFUSION CARE NORTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOMASKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-732-4879
Mailing Address - Street 1:854 N CENTER AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1686
Mailing Address - Country:US
Mailing Address - Phone:989-732-4879
Mailing Address - Fax:989-731-0707
Practice Address - Street 1:854 N CENTER AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1686
Practice Address - Country:US
Practice Address - Phone:989-732-4879
Practice Address - Fax:989-731-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301005584251F00000X, 332B00000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3046513Medicaid
MI0483990001OtherDMERC