Provider Demographics
NPI:1639456031
Name:EXPERIENCE INFUSION CENTERS I-45 WOODLANDS, LLC
Entity Type:Organization
Organization Name:EXPERIENCE INFUSION CENTERS I-45 WOODLANDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-364-1111
Mailing Address - Street 1:6300 RICHMOND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5952
Mailing Address - Country:US
Mailing Address - Phone:713-364-1111
Mailing Address - Fax:713-364-1112
Practice Address - Street 1:25510 I-45 NORTH SUITE 202
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386
Practice Address - Country:US
Practice Address - Phone:713-364-1111
Practice Address - Fax:713-364-1112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXPERIENCE INFUSION CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy