Healthcare Provider Details

I. General information

NPI: 1669692331
Provider Name (Legal Business Name): PATIENT CARE INFUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 11/05/2010
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 TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number303
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number303
License Number StateAZ

VIII. Authorized Official

Name: MR. ROBERT ALLEN COSTON
Title or Position: AR MANAGER
Credential:
Phone: 602-252-5000