Healthcare Provider Details

I. General information

NPI: 1821509548
Provider Name (Legal Business Name): INFINITY MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 09/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 SAN JUAN BLVD
FARMINGTON NM
87401-2220
US

IV. Provider business mailing address

2012 SAN JUAN BLVD
FARMINGTON NM
87401-2220
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-0963
  • Fax: 505-436-2294
Mailing address:
  • Phone: 505-325-0963
  • Fax: 505-436-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DANIEL RAY LORETT
Title or Position: MANAGING PARTNER
Credential: RRT
Phone: 505-325-0963