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General NPI Number Information
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NPI Number | 1629651476
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Entity Type | Organization
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Legal Business Name | ATTIGO INFUSION MISSOURI LLC
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 1520 N CHURCH RD STE D
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City | LIBERTY
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State | MO
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Zip | 64068-7176
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Country | US
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Telephone | 972-661-2273
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Fax | 972-421-1899
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Provider Business Mailing Address
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Address Line | 15301 SPECTRUM DR STE 330
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City | ADDISON
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State | TX
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Zip | 75001-6462
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Country | US
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Telephone | 972-661-2273
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Fax | 972-421-1899
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE CYCLE
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Name | MAUREEN CRAVEN
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Credential |
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Telephone | 972-661-2273
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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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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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