MEDICARE: PARK INFUSIONCARE LP

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	3336H0001X	Home Infusion Therapy Pharmacy	21055	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2098189	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336150424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK INFUSIONCARE LP

Provider Business Mailing Address
First Line	:	PO BOX 40700
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85274-0700
Country	:	US
Telephone Number	:	480-446-9010
Fax Number	:	480-993-2033

Provider Business Practice Location Address
First Line	:	4007 BELLAIRE BLVD
Second Line	:	STE G
City	:	HOUSTON
State	:	TX
Zip	:	77025
Country	:	US
Telephone Number	:	713-668-7275
Fax Number	:	866-925-5620

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM KEYS
Credential	:
Telephone Number	:	480-446-9010

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	08/06/2018

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Directions to “PARK INFUSIONCARE LP ” Practice Location

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