Provider Demographics
NPI:1720082449
Name:OUTPATIENT INFUSION SYSTEMS, INC.
Entity Type:Organization
Organization Name:OUTPATIENT INFUSION SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-893-8457
Mailing Address - Street 1:800 TECHNOLOGY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4721
Mailing Address - Country:US
Mailing Address - Phone:781-344-6000
Mailing Address - Fax:781-344-7244
Practice Address - Street 1:800 TECHNOLOGY CENTER DR
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4721
Practice Address - Country:US
Practice Address - Phone:781-344-6000
Practice Address - Fax:781-344-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003194033AMedicaid
SCDM1094Medicaid
GA000977688AMedicaid
SCDM1094Medicaid