Provider Demographics
NPI:1689761462
Name:PARK INFUSIONCARE, L.P.
Entity Type:Organization
Organization Name:PARK INFUSIONCARE, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-446-9010
Mailing Address - Street 1:PO BOX 40700
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274-0700
Mailing Address - Country:US
Mailing Address - Phone:480-446-9010
Mailing Address - Fax:480-446-7695
Practice Address - Street 1:4319 MEDICAL DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-615-7475
Practice Address - Fax:210-614-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 3336M0002X
TX20559332BP3500X, 332BX2000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130719107Medicaid
TX130719102Medicaid
TX130719106Medicaid
TX320223Medicaid
TX130719107Medicaid