Provider Demographics
NPI:1841291499
Name:CHESAPEAKE INFUSION INC.
Entity type:Organization
Organization Name:CHESAPEAKE INFUSION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-854-6532
Mailing Address - Street 1:6272 LEE VISTA BLVD
Mailing Address - Street 2:LEGAL DEPT
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5148
Mailing Address - Country:US
Mailing Address - Phone:888-773-7376
Mailing Address - Fax:888-773-7386
Practice Address - Street 1:2175 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 1 BUILDING C
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-5628
Practice Address - Country:US
Practice Address - Phone:800-260-6667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3587333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4044129Medicaid
MS330689Medicaid