Provider Demographics
NPI:1992700439
Name:INFUSACARE, INC.
Entity type:Organization
Organization Name:INFUSACARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:B.
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:601-956-5272
Mailing Address - Street 1:PO BOX 2720
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-2720
Mailing Address - Country:US
Mailing Address - Phone:601-956-5272
Mailing Address - Fax:601-956-2474
Practice Address - Street 1:864 WILSON DR
Practice Address - Street 2:STE A
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4512
Practice Address - Country:US
Practice Address - Phone:601-956-5272
Practice Address - Fax:601-956-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS02417 / 02.1251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440102Medicaid
MS00330067Medicaid
MS00112016Medicaid
MS0608030001Medicare ID - Type Unspecified