Provider Demographics
NPI:1649564535
Name:SONAS INFUSION CENTER, LLC
Entity Type:Organization
Organization Name:SONAS INFUSION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-247-2500
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77252-2065
Mailing Address - Country:US
Mailing Address - Phone:281-820-1900
Mailing Address - Fax:281-820-1901
Practice Address - Street 1:3750 MAIN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4033
Practice Address - Country:US
Practice Address - Phone:970-247-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO186468261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO186468OtherSTATE LICENSURE