Provider Demographics
NPI:1972827541
Name:SPECTRUM INFUSION, INC
Entity Type:Organization
Organization Name:SPECTRUM INFUSION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:WICKER
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-781-2241
Mailing Address - Street 1:3221 BLUE RIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8063
Mailing Address - Country:US
Mailing Address - Phone:919-781-2241
Mailing Address - Fax:919-781-7060
Practice Address - Street 1:3221 BLUE RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8063
Practice Address - Country:US
Practice Address - Phone:919-781-2241
Practice Address - Fax:919-781-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6231332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6231OtherNC STATE PHARMACY LICENSE #
NC0929454Medicaid
NC3434684OtherNABP #
NC1173200001Medicare NSC