Provider Demographics
NPI:1821509548
Name:INFINITY MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:INFINITY MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LORETT
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:505-325-0963
Mailing Address - Street 1:2012 SAN JUAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2220
Mailing Address - Country:US
Mailing Address - Phone:505-325-0963
Mailing Address - Fax:505-436-2294
Practice Address - Street 1:2012 SAN JUAN BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2220
Practice Address - Country:US
Practice Address - Phone:505-325-0963
Practice Address - Fax:505-436-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function TechnologistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM625836300OtherDEEOIC