MEDICARE: SPECIALTY INFUSION 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
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1750933230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY INFUSION LLC

Provider Business Mailing Address
First Line	:	1812 AVENUE OF AMERICA STE 2
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-4530
Country	:	US
Telephone Number	:	318-855-0842
Fax Number	:	318-322-1084

Provider Business Practice Location Address
First Line	:	1812 AVENUE OF AMERICA STE 4
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-4520
Country	:	US
Telephone Number	:	318-855-0842
Fax Number	:

Authorized Official
Title or Position	:	MANAGE
Name	:	NICOLE TOOMER-TATUM
Credential	:
Telephone Number	:	318-855-0841

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	12/19/2025

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Directions to “SPECIALTY INFUSION LLC ” Practice Location

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