Healthcare Provider Details

I. General information

NPI: 1922706365
Provider Name (Legal Business Name): INFINITY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N UNION ST STE 1
WILMINGTON DE
19805-5334
US

IV. Provider business mailing address

910 N UNION ST STE 1
WILMINGTON DE
19805-5334
US

V. Phone/Fax

Practice location:
  • Phone: 610-360-0636
  • Fax:
Mailing address:
  • Phone: 610-360-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN VON RAHDER
Title or Position: ADMINSTRATOR
Credential:
Phone: 610-360-0636