MEDICARE: 1ST AMERICA INFUSION SERVICES 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	PHRE008040	GA
3	3336S0011X	Specialty Pharmacy
4	3336H0001X	Home Infusion Therapy Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2019860	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851309595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST AMERICA INFUSION SERVICES LLC

Provider Business Mailing Address
First Line	:	212 NORTHSIDE DR
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-1858
Country	:	US
Telephone Number	:	229-242-3040
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 NORTHSIDE DR
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-1858
Country	:	US
Telephone Number	:	229-242-3060
Fax Number	:	292-242-9914

Authorized Official
Title or Position	:	CEO
Name	:	SIMON CASTELLANOS
Credential	:
Telephone Number	:	601-988-1700

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	11/04/2022

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