Basic Information
| Provider Information | |||||||||
| NPI: | 1790098416 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INFINITY FAMILY PRACTICE ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1080 NEAL ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385010942 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 9316147517 | ||||||||
| Practice Location | |||||||||
| Address1: | 1080 NEAL ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385010942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315201529 | ||||||||
| FaxNumber: | 9316147517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2010 | ||||||||
| LastUpdateDate: | 05/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | CASAL | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9315263316 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.