MEDICARE: ADVANCED INFUSION SYSTEMS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	PHY 48702	CA
2	333600000X	Pharmacy	PHY 48702	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003819194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED INFUSION SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	3802 CORPOREX PARK DR
Second Line	:	STE 200
City	:	TAMPA
State	:	FL
Zip	:	33619-1125
Country	:	US
Telephone Number	:	813-318-6039
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 E DANA ST
Second Line	:	SUITE A
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94041-1507
Country	:	US
Telephone Number	:	650-961-6355
Fax Number	:	650-969-5653

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. THOMAS A. CANERIS
Credential	:
Telephone Number	:	502-627-7100

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/18/2013

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