Basic Information
| Provider Information | |||||||||
| NPI: | 1013250018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE CLINICAL INFUSION CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 S MILL AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852822138 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3303 S LINDSAY RD | ||||||||
| Address2: | SUITE 123 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852971503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808219939 | ||||||||
| FaxNumber: | 4808219555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 03/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | NWAFOR | ||||||||
| AuthorizedOfficialFirstName: | TOCHUKWU | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 4808219339 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HANNAH MEDICAL INSTITUTE LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 29620 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.