Provider Demographics
NPI:1831181072
Name:MEDWAY INFUSION SERVICES LLC
Entity type:Organization
Organization Name:MEDWAY INFUSION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-588-1000
Mailing Address - Street 1:3123 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6801
Mailing Address - Country:US
Mailing Address - Phone:325-944-0300
Mailing Address - Fax:972-588-1001
Practice Address - Street 1:3123 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6801
Practice Address - Country:US
Practice Address - Phone:325-944-0300
Practice Address - Fax:325-944-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26833251F00000X, 3336H0001X
332B00000X, 332BP3500X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX750838OtherBCBS
TX26833OtherSTATE BOARD OF PHARMACY
TX5459850001Medicare NSC