Provider Demographics
NPI:1184755399
Name:DIVERSIFIED INFUSIONCARE SOLUTIONS, INC
Entity type:Organization
Organization Name:DIVERSIFIED INFUSIONCARE SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINWINDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:662-320-9696
Mailing Address - Street 1:403 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2164
Mailing Address - Country:US
Mailing Address - Phone:662-320-9696
Mailing Address - Fax:662-320-9616
Practice Address - Street 1:403 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2164
Practice Address - Country:US
Practice Address - Phone:662-320-9696
Practice Address - Fax:662-320-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE8018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS041-19589-02OtherMS PHARMACY PERMIT
2519710OtherNABP#