Provider Demographics
NPI:1447791926
Name:PROFESSIONAL INFUSION CONSULTANTS CORPORATION
Entity Type:Organization
Organization Name:PROFESSIONAL INFUSION CONSULTANTS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:630-205-2924
Mailing Address - Street 1:1628 WINDWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1896
Mailing Address - Country:US
Mailing Address - Phone:630-205-2924
Mailing Address - Fax:
Practice Address - Street 1:1628 WINDWARD AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1896
Practice Address - Country:US
Practice Address - Phone:630-205-2924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1OtherBILLING