Healthcare Provider Details

I. General information

NPI: 1306943956
Provider Name (Legal Business Name): PROFESSIONAL PICC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WOODVIEW DR
CORTLAND OH
44410-1247
US

IV. Provider business mailing address

115 WOODVIEW DR
CORTLAND OH
44410-1247
US

V. Phone/Fax

Practice location:
  • Phone: 330-637-9112
  • Fax:
Mailing address:
  • Phone: 330-637-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. ALBERT ANDREW SMULIK
Title or Position: CEO
Credential:
Phone: 330-637-1940