Provider Demographics
NPI:1922558352
Name:MIDTOWN INFUSION CENTER
Entity Type:Organization
Organization Name:MIDTOWN INFUSION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-250-1325
Mailing Address - Street 1:1445 GEORGIA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7610
Mailing Address - Country:US
Mailing Address - Phone:478-250-1325
Mailing Address - Fax:478-254-6860
Practice Address - Street 1:1445 GEORGIA AVE STE 2
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7610
Practice Address - Country:US
Practice Address - Phone:478-250-1325
Practice Address - Fax:478-254-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy