MEDICARE: AMBULATORY INFUSION SPECIALIST, 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	:	1568696623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULATORY INFUSION SPECIALIST, LLC.

Provider Business Mailing Address
First Line	:	1332 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3730
Country	:	US
Telephone Number	:	866-778-8255
Fax Number	:	866-398-2988

Provider Business Practice Location Address
First Line	:	1332 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3730
Country	:	US
Telephone Number	:	866-778-8255
Fax Number	:	866-398-2988

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. CATHY ANN BRUMBAUGH
Credential	:	CMS
Telephone Number	:	866-778-8255

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	05/05/2009

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