Provider Demographics
NPI:1477616233
Name:KABAFUSION AR, LLC
Entity Type:Organization
Organization Name:KABAFUSION AR, LLC
Other - Org Name:KABAFUSION AR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-435-3020
Mailing Address - Street 1:80 HAYDEN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEXITON
Mailing Address - State:MA
Mailing Address - Zip Code:02421
Mailing Address - Country:US
Mailing Address - Phone:800-435-3020
Mailing Address - Fax:877-524-9504
Practice Address - Street 1:2520 ALEXANDER DR
Practice Address - Street 2:STE C
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-972-8839
Practice Address - Fax:870-802-4687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0294030622Medicare NSC