MEDICARE: INFINITY HEALTH CARE

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	3336C0003X	Community/Retail Pharmacy	4986-IR	LA

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

General Provider Information

NPI Number	:	1588680862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY HEALTH CARE

Provider Business Mailing Address
First Line	:	2881 POYDRAS BAYOU RD
Second Line	:
City	:	ERWINVILLE
State	:	LA
Zip	:	70729-3422
Country	:	US
Telephone Number	:	225-627-9581
Fax Number	:

Provider Business Practice Location Address
First Line	:	8894 AIRLINE HWY
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-4081
Country	:	US
Telephone Number	:	225-922-7979
Fax Number	:	225-922-9494

Authorized Official
Title or Position	:	CEO
Name	:	MRS. AIMEE ELIZABETH HILLIS
Credential	:	RPH
Telephone Number	:	225-922-7979

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	02/20/2008

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