Healthcare Provider Details

I. General information

NPI: 1750933230
Provider Name (Legal Business Name): SPECIALTY INFUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 AVENUE OF AMERICA STE 4
MONROE LA
71201-4520
US

IV. Provider business mailing address

1812 AVENUE OF AMERICA STE 2
MONROE LA
71201-4530
US

V. Phone/Fax

Practice location:
  • Phone: 318-855-0842
  • Fax:
Mailing address:
  • Phone: 318-855-0842
  • Fax: 318-322-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE TOOMER-TATUM
Title or Position: MANAGE
Credential:
Phone: 318-855-0841