Provider Demographics
NPI:1982630976
Name:CENTRAL LINE INFUSION, LTD
Entity Type:Organization
Organization Name:CENTRAL LINE INFUSION, LTD
Other - Org Name:AMERITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILOLAHTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-282-2382
Mailing Address - Street 1:6912 S QUENTIN ST STE 50
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4531
Mailing Address - Country:US
Mailing Address - Phone:720-282-5325
Mailing Address - Fax:877-302-5251
Practice Address - Street 1:603 QUAIL CREEK
Practice Address - Street 2:STE 700
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1651
Practice Address - Country:US
Practice Address - Phone:806-352-1212
Practice Address - Fax:806-352-1211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERITA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-23
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24991332B00000X, 332BP3500X, 3336H0001X
335G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4593403OtherNCPDP
TX1982630976Medicaid
TX24991OtherBOARD OF PHARMACY
BC4222408OtherDEA
TX320130OtherTEXAS VENDOR DRUG PROGRAM
TX320130OtherTEXAS VENDOR DRUG PROGRAM