Provider Demographics
NPI:1629791157
Name:INNOVATIVE INFUSIONS, LLC
Entity Type:Organization
Organization Name:INNOVATIVE INFUSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-588-1000
Mailing Address - Street 1:3033 W PRESIDENT GEORGE BUSH HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5752
Mailing Address - Country:US
Mailing Address - Phone:972-588-1000
Mailing Address - Fax:
Practice Address - Street 1:3255 MALCOLM DRIVE, SUITE 3255
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-8816
Practice Address - Country:US
Practice Address - Phone:334-310-9942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE INFUSIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty