Healthcare Provider Details

I. General information

NPI: 1831934348
Provider Name (Legal Business Name): PROMPTCARE HOME INFUSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 LUNDY LN STE 120
HATTIESBURG MS
39401-6601
US

IV. Provider business mailing address

41 SPRING ST STE 103B
NEW PROVIDENCE NJ
07974-1143
US

V. Phone/Fax

Practice location:
  • Phone: 601-910-7279
  • Fax:
Mailing address:
  • Phone: 866-776-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHEN A LARIVIERE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 866-776-6782