Basic Information
| Provider Information | |||||||||
| NPI: | 1417084161 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OPTION CARE TROY, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ACTIVE INFUSION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2845 CROOKS RD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483093661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485897755 | ||||||||
| FaxNumber: | 2485892644 | ||||||||
| Practice Location | |||||||||
| Address1: | 25219 DEQUINDRE RD | ||||||||
| Address2: | |||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480714211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485897755 | ||||||||
| FaxNumber: | 2485892644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | FILIPPIS | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2488298282 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 4620050 | 05 | MI | MEDICAID | 540F310380 | 01 | MI | BCBSM DME | OTHER |