Provider Demographics
NPI:1790294668
Name:PROFUSION, LLC
Entity Type:Organization
Organization Name:PROFUSION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-734-1118
Mailing Address - Street 1:3200 STECK AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8034
Mailing Address - Country:US
Mailing Address - Phone:512-371-7020
Mailing Address - Fax:512-371-7029
Practice Address - Street 1:3200 STECK AVE STE 330
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8034
Practice Address - Country:US
Practice Address - Phone:512-371-7020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-23
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31917251F00000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy