Provider Demographics
NPI:1750580353
Name:PICC LINES PLUS LLC
Entity type:Organization
Organization Name:PICC LINES PLUS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARIVIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-776-6782
Mailing Address - Street 1:300 BUSINESS PARK WAY STE A-1
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1756
Mailing Address - Country:US
Mailing Address - Phone:561-736-5161
Mailing Address - Fax:561-736-7683
Practice Address - Street 1:300 BUSINESS PARK WAY STE A-1
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1756
Practice Address - Country:US
Practice Address - Phone:561-736-5161
Practice Address - Fax:561-736-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X, 3336S0011X
FLPH232713336H0001X, 3336H0001X, 3336S0011X
NC112503336C0004X
AL1134263336H0001X
SC110753336H0001X
IL054.0166933336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023018500Medicaid
FL023018501Medicaid
FL005979000Medicaid