MEDICARE: 1488 INFUSION CENTER

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		TX

General Provider Information

NPI Number	:	1477007466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1488 INFUSION CENTER

Provider Business Mailing Address
First Line	:	PO BOX 132285
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77393-2285
Country	:	US
Telephone Number	:	832-813-8280
Fax Number	:	800-500-2344

Provider Business Practice Location Address
First Line	:	114 VISION PARK BLVD STE 102
Second Line	:
City	:	SHENANDOAH
State	:	TX
Zip	:	77384-3008
Country	:	US
Telephone Number	:	832-813-8932
Fax Number	:	888-883-9901

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	STEVE ROPHAIL
Credential	:
Telephone Number	:	713-679-4487

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	11/07/2019

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