Provider Demographics
NPI:1760435382
Name:CISCURA, INC
Entity Type:Organization
Organization Name:CISCURA, INC
Other - Org Name:CISCURA INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLLYNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:KLEM
Authorized Official - Suffix:
Authorized Official - Credentials:RN CRNI OCN
Authorized Official - Phone:678-762-1520
Mailing Address - Street 1:360 WINKLER DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-0764
Mailing Address - Country:US
Mailing Address - Phone:678-762-1520
Mailing Address - Fax:678-762-1521
Practice Address - Street 1:360 WINKLER DR
Practice Address - Street 2:SUITE F
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-0764
Practice Address - Country:US
Practice Address - Phone:678-762-1520
Practice Address - Fax:678-762-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA073277194AMedicaid
GA52212542-001OtherBCBS
SCDM1243Medicaid
GA073277194AMedicaid