MEDICARE: CONSULTANTS IN INFECTIOUS DISEASES

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	15037	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	082062301	OTHER	TX	FIRST CARE STAR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	750678	OTHER	TX	BCBS HOME INFUSION THERAPY
5	0541920001	OTHER	TX	PALMETTO GBA
6	082062301	OTHER		FIRST CARE STAR
7	103131100	OTHER	TX	FIRST CARE

General Provider Information

NPI Number	:	1588997225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSULTANTS IN INFECTIOUS DISEASES

Provider Business Mailing Address
First Line	:	PO BOX 16327
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79490-6327
Country	:	US
Telephone Number	:	806-795-8150
Fax Number	:	806-791-6688

Provider Business Practice Location Address
First Line	:	4404 19TH ST
Second Line	:	STE. C
City	:	LUBBOCK
State	:	TX
Zip	:	79407-2424
Country	:	US
Telephone Number	:	806-795-8150
Fax Number	:	806-791-6688

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TONI ANN CLINE
Credential	:	PA-C
Telephone Number	:	806-795-8150

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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Directions to “CONSULTANTS IN INFECTIOUS DISEASES ” Practice Location

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