Healthcare Provider Details

I. General information

NPI: 1629651476
Provider Name (Legal Business Name): ATTIGO INFUSION MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N CHURCH RD STE D
LIBERTY MO
64068-7176
US

IV. Provider business mailing address

15301 SPECTRUM DR STE 330
ADDISON TX
75001-6462
US

V. Phone/Fax

Practice location:
  • Phone: 972-661-2273
  • Fax: 972-421-1899
Mailing address:
  • Phone: 972-661-2273
  • Fax: 972-421-1899

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 Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN CRAVEN
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 972-661-2273