Provider Demographics
NPI:1467711028
Name:MEDICAL INFUSION TECHNOLOGIES, INC.
Entity Type:Organization
Organization Name:MEDICAL INFUSION TECHNOLOGIES, INC.
Other - Org Name:MEDICAL INFUSION TECHNOLOGIES DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-3122
Mailing Address - Street 1:115 ECHOLS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2527
Mailing Address - Country:US
Mailing Address - Phone:912-691-0333
Mailing Address - Fax:912-691-1030
Practice Address - Street 1:115 ECHOLS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2527
Practice Address - Country:US
Practice Address - Phone:912-691-0333
Practice Address - Fax:912-691-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE007353332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000493259BMedicaid
GA000493259BMedicaid