Provider Demographics
NPI:1316257058
Name:AFFINITY BIOTECH, INC.
Entity type:Organization
Organization Name:AFFINITY BIOTECH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-994-3652
Mailing Address - Street 1:1001 E 101ST TER
Mailing Address - Street 2:STE. 240
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3367
Mailing Address - Country:US
Mailing Address - Phone:816-994-3652
Mailing Address - Fax:816-994-2551
Practice Address - Street 1:11303 CHIMNEY ROCK RD
Practice Address - Street 2:STE. 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-2901
Practice Address - Country:US
Practice Address - Phone:713-551-2087
Practice Address - Fax:888-805-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX268453336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1063748812OtherNPI
TX4555299OtherNCPDP
TX146147Medicaid