Provider Demographics
NPI:1992311658
Name:INDEPENDENCE INFUSION SERVICES, INC
Entity type:Organization
Organization Name:INDEPENDENCE INFUSION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-980-9009
Mailing Address - Street 1:986 TIBBETTS WICK RD
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1138
Mailing Address - Country:US
Mailing Address - Phone:330-306-9651
Mailing Address - Fax:
Practice Address - Street 1:986 TIBBETTS WICK RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1138
Practice Address - Country:US
Practice Address - Phone:330-980-9009
Practice Address - Fax:330-395-0133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATRIOT HOUSECALL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy