Healthcare Provider Details

I. General information

NPI: 1295707933
Provider Name (Legal Business Name): PATIENT CARE INFUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 S EDWARD DR
TEMPE AZ
85281-6200
US

IV. Provider business mailing address

1626 S EDWARD DR
TEMPE AZ
85281-6200
US

V. Phone/Fax

Practice location:
  • Phone: 602-252-5000
  • Fax: 602-323-5070
Mailing address:
  • Phone: 602-252-5000
  • Fax: 602-323-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberY002667
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number303
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number303
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberC000303
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2667
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code3336N0007X
TaxonomyNuclear Pharmacy
License Number7572
License Number StateAZ
# 7
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number2667
License Number StateAZ

VIII. Authorized Official

Name: MR. ROBERT ALLEN COSTON
Title or Position: A R MANAGER
Credential:
Phone: 602-445-1745