MEDICARE: INNOVATIVE INFUSIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1316669245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE INFUSIONS, LLC

Provider Business Mailing Address
First Line	:	3033 W PRESIDENT GEORGE BUSH HWY STE 100B
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-5885
Country	:	US
Telephone Number	:	972-588-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4851 CAHABA RIVER RD STE 137
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-2359
Country	:	US
Telephone Number	:	205-963-7523
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	NICHOLAS DANIEL MAROULIS
Credential	:
Telephone Number	:	689-263-5021

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	06/05/2026

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