Provider Demographics
NPI:1285795591
Name:INFUSAL PARTNERS
Entity type:Organization
Organization Name:INFUSAL PARTNERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHENNEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-855-6910
Mailing Address - Street 1:14328 COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1501
Mailing Address - Country:US
Mailing Address - Phone:305-362-5599
Mailing Address - Fax:
Practice Address - Street 1:14328 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1501
Practice Address - Country:US
Practice Address - Phone:305-362-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X, 332BP3500X, 3336L0003X, 3336S0011X
FLPH14063332BP3500X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2431239OtherAETNA HOME HEALTH
FL51622OtherJCAHO
FL032069201Medicaid
FL103780300Medicaid
FL1013729OtherACM
FL1078787OtherNCPDP
FL2431247OtherAETNA INFUSION
FLJQ3OtherBCBS
FL032069200Medicaid
FL2124149OtherAETNA DME
FL2124149OtherAETNA DME
FLBI4945208OtherDEA
FL2431239OtherAETNA HOME HEALTH