Provider Demographics
NPI:1770665556
Name:INFUSION TECHNOLOGIES INC
Entity Type:Organization
Organization Name:INFUSION TECHNOLOGIES INC
Other - Org Name:INFUSION TECHNOLOGIES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTOMAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-887-9335
Mailing Address - Street 1:820 NE 126TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4906
Mailing Address - Country:US
Mailing Address - Phone:305-887-9335
Mailing Address - Fax:305-883-8869
Practice Address - Street 1:3728 PHILLIPS HWY
Practice Address - Street 2:STE. 212
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9300
Practice Address - Country:US
Practice Address - Phone:904-399-3332
Practice Address - Fax:904-399-3383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336S0011X
FLPH200703336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02684450Medicaid
1007702OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA1012158610001Medicaid
KY54010996Medicaid
OH2610795Medicaid
1007702OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL02684450Medicaid