Provider Demographics
NPI:1669692331
Name:PATIENT CARE INFUSION
Entity type:Organization
Organization Name:PATIENT CARE INFUSION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:COSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-252-5000
Mailing Address - Street 1:1626 S EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6200
Mailing Address - Country:US
Mailing Address - Phone:602-252-5000
Mailing Address - Fax:602-323-5070
Practice Address - Street 1:1626 S EDWARD DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6200
Practice Address - Country:US
Practice Address - Phone:602-252-5000
Practice Address - Fax:602-323-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ303332BX2000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ312512Medicaid
AZ312512Medicaid