=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730694472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FUSION HEALTHCARE SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2017
-----------------------------------------------------
Last Update Date | 12/04/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 S VALLEY RD STE 209
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301-1473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-644-4031
-----------------------------------------------------
Fax | 800-819-7752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 S VALLEY RD STE 209
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301-1473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-644-4031
-----------------------------------------------------
Fax | 800-819-7752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARK ALBERT RUBINO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-620-9031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------