Healthcare Provider Details

I. General information

NPI: 1053382770
Provider Name (Legal Business Name): ADVANCED INFUSION MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 N FIVE MILE RD
BOISE ID
83713-8025
US

IV. Provider business mailing address

627 N FIVE MILE RD
BOISE ID
83713-8025
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-2246
  • Fax: 208-376-2249
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number1980LS
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES TANZINI
Title or Position: MEMBER
Credential: RPH
Phone: 208-376-2246