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General NPI Number Information
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NPI Number | 1578146924
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Entity Type | Organization
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Legal Business Name | 1ST AMERICA INFUSION SERVICES LLC
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 2320 E NORTH ST STE GG-104
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City | GREENVILLE
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State | SC
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Zip | 29607-1247
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Country | US
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Telephone | 229-242-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 212 NORTHSIDE DR
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City | VALDOSTA
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State | GA
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Zip | 31602-1858
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SIMON CASTELLANOS
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Credential |
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Telephone | 601-988-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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