Healthcare Provider Details

I. General information

NPI: 1790294668
Provider Name (Legal Business Name): PROFUSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2017
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 STECK AVE STE 330
AUSTIN TX
78757-8034
US

IV. Provider business mailing address

3200 STECK AVE STE 330
AUSTIN TX
78757-8034
US

V. Phone/Fax

Practice location:
  • Phone: 512-371-7020
  • Fax:
Mailing address:
  • Phone: 512-371-7020
  • Fax: 512-371-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number31917
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number31917
License Number StateTX

VIII. Authorized Official

Name: DAMON FAUGHT
Title or Position: MEMBER
Credential:
Phone: 512-734-1118