Provider Demographics
NPI:1700970936
Name:ADVANCED INFUSION SPECIALISTS LLC
Entity Type:Organization
Organization Name:ADVANCED INFUSION SPECIALISTS LLC
Other - Org Name:EAGLE CONSULTING LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:517-694-0900
Mailing Address - Street 1:6910 S CEDAR ST
Mailing Address - Street 2:STE 2
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-6912
Mailing Address - Country:US
Mailing Address - Phone:517-694-0900
Mailing Address - Fax:517-694-0909
Practice Address - Street 1:6910 S CEDAR ST
Practice Address - Street 2:STE 2
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-6912
Practice Address - Country:US
Practice Address - Phone:517-694-0900
Practice Address - Fax:517-694-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2320012813Medicaid
MI2320012813Medicaid