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General NPI Number Information
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NPI Number | 1790294668
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Entity Type | Organization
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Legal Business Name | PROFUSION, LLC
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Dates
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Enumeration Date | 09/23/2017
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 3200 STECK AVE STE 330
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City | AUSTIN
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State | TX
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Zip | 78757-8034
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Country | US
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Telephone | 512-371-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 STECK AVE STE 330
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City | AUSTIN
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State | TX
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Zip | 78757-8034
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Country | US
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Telephone | 512-371-7020
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Fax | 512-371-7029
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Authorized Official
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Title or Position | MEMBER
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Name | DAMON FAUGHT
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Credential |
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Telephone | 512-734-1118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 31917
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 31917
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License Number State | TX
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