Provider Demographics
NPI:1700195153
Name:THE INFUSION CLINIC
Entity Type:Organization
Organization Name:THE INFUSION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-915-1126
Mailing Address - Street 1:PO BOX 4015
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-4015
Mailing Address - Country:US
Mailing Address - Phone:423-915-1126
Mailing Address - Fax:423-915-0635
Practice Address - Street 1:1936 BROOKSIDE DR
Practice Address - Street 2:SUITE D
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4654
Practice Address - Country:US
Practice Address - Phone:423-943-4790
Practice Address - Fax:888-505-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37711207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3886961Medicaid
TN3886961Medicaid