Healthcare Provider Details

I. General information

NPI: 1629791157
Provider Name (Legal Business Name): INNOVATIVE INFUSIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 MALCOLM DRIVE, SUITE 3255
MONTGOMERY AL
36116-8816
US

IV. Provider business mailing address

3033 W PRESIDENT GEORGE BUSH HWY STE 100B
PLANO TX
75075-5885
US

V. Phone/Fax

Practice location:
  • Phone: 334-310-9942
  • Fax:
Mailing address:
  • Phone: 972-588-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS DANIEL MAROULIS
Title or Position: VICE PRESIDENT
Credential:
Phone: 689-263-5021