Provider Demographics
NPI:1336432962
Name:INFINITY MEDICAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:INFINITY MEDICAL MANAGEMENT, LLC
Other - Org Name:PARK AVENUE MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-646-1862
Mailing Address - Street 1:1761 PARK AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1618
Mailing Address - Country:US
Mailing Address - Phone:276-325-0417
Mailing Address - Fax:276-325-0394
Practice Address - Street 1:1761 PARK AVE SW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1608
Practice Address - Country:US
Practice Address - Phone:276-325-0417
Practice Address - Fax:276-926-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336432962Medicaid