Provider Demographics
NPI:1053514976
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 1:5505 JOHNS ROAD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634
Mailing Address - Country:US
Mailing Address - Phone:888-744-4638
Mailing Address - Fax:813-549-5490
Practice Address - Street 1:5505 JOHNS RD
Practice Address - Street 2:SUITE 700
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4307
Practice Address - Country:US
Practice Address - Phone:888-744-4638
Practice Address - Fax:813-549-5490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFUSAL PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-07
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032318700Medicaid
FL032318700Medicaid