Healthcare Provider Details

I. General information

NPI: 1487269254
Provider Name (Legal Business Name): INFUSE ONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 RURAL ACRES DR STE A
BECKLEY WV
25801-3579
US

IV. Provider business mailing address

117 RURAL ACRES DR STE A
BECKLEY WV
25801-3579
US

V. Phone/Fax

Practice location:
  • Phone: 304-860-1446
  • Fax: 304-894-8513
Mailing address:
  • Phone: 304-860-1446
  • Fax: 304-894-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER MARTIN
Title or Position: OWNER
Credential:
Phone: 304-940-1395