Basic Information
| Provider Information | |||||||||
| NPI: | 1982983862 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KABAFUSION AR, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KABAFUSION AR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 HAYDEN AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004353020 | ||||||||
| FaxNumber: | 8775249504 | ||||||||
| Practice Location | |||||||||
| Address1: | 4015 MASSARD RD | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794780121 | ||||||||
| FaxNumber: | 4794780138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2011 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | MASOOD | ||||||||
| AuthorizedOfficialFirstName: | SOHAIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8004353020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 3336H0001X | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
No ID Information.