Basic Information
| Provider Information | |||||||||
| NPI: | 1891761466 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRI-MED INFUSION SERVICES INC | ||||||||
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| OtherOrganizationName: | KABAFUSION IL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17777 CENTER COURT DR N | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004353020 | ||||||||
| FaxNumber: | 5626455396 | ||||||||
| Practice Location | |||||||||
| Address1: | 5517 N CUMBERLAND AVE | ||||||||
| Address2: | SUITE 915 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606564738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734676000 | ||||||||
| FaxNumber: | 7737752732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 06/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | RIGAS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF CLINICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8004353020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARM. D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 054018991 | IL | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BP3500X | 64001952A | IN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 333600000X | N | Suppliers | Pharmacy | 3336C0003X | 2016031249 | MO | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0004X | 337-43 | WI | N | Suppliers | Pharmacy | Compounding Pharmacy | 3336S0011X | N | Suppliers | Pharmacy | Specialty Pharmacy | 3336H0001X | 4825 | IA | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 1891761466 | 05 | MO | MEDICAID | 2021821 | 01 | PK | OTHER | 201406040A | 05 | IN | MEDICAID |