1174616072 NPI number — HBC INFUSION SERVICES, LLC

Table of content: (NPI 1174616072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174616072 NPI number — HBC INFUSION SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HBC INFUSION SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174616072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4520 LINDEN CREEK
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-720-3775
Provider Business Mailing Address Fax Number:
810-720-3835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7277 BERNICE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CENTERLINE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-155-2496
Provider Business Practice Location Address Fax Number:
586-497-9364
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOM
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
GERARD
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
810-733-0280

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4703528 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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