Provider Demographics
NPI:1699402453
Name:INFINITI HEALTHCARE SOLUTIONS
Entity type:Organization
Organization Name:INFINITI HEALTHCARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHHENICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SORRELS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:601-618-6149
Mailing Address - Street 1:3530 MANOR DR STE 6A
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5625
Mailing Address - Country:US
Mailing Address - Phone:601-618-6149
Mailing Address - Fax:
Practice Address - Street 1:3530 MANOR DR STE 6A
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5625
Practice Address - Country:US
Practice Address - Phone:601-618-6149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty