Provider Demographics
NPI:1881923738
Name:INFUSION RESOURCE, LLC
Entity type:Organization
Organization Name:INFUSION RESOURCE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-992-7068
Mailing Address - Street 1:74 FAUNCE CORNER ROAD
Mailing Address - Street 2:SUITE #610
Mailing Address - City:N. DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:774-992-7068
Mailing Address - Fax:774-992-7069
Practice Address - Street 1:74 FAUNCE CORNER ROAD
Practice Address - Street 2:SUITE #610
Practice Address - City:N. DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747
Practice Address - Country:US
Practice Address - Phone:774-992-7068
Practice Address - Fax:774-992-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
MA332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084396BMedicaid
MA6247700002Medicare NSC