MEDICARE: 1ST AMERICA INFUSION SERVICES LLC

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	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1427748680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST AMERICA INFUSION SERVICES LLC

Provider Business Mailing Address
First Line	:	212 NORTHSIDE DR
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-1858
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2351 ENERGY DR STE D
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-2618
Country	:	US
Telephone Number	:	800-482-8466
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JUDERAL HALL
Credential	:
Telephone Number	:	800-482-8466

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	05/11/2023

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