Organization
1ST AMERICA INFUSION SERVICES LLC
Active
Other names
Advanced InfusionCare
Organization subpart
No
Provider details
NPI number
Authorized official
SIMON CASTELLANOS (CEO)
(601) 988-1700
Entity
Organization
Contact information
Practice address
212 NORTHSIDE DR, VALDOSTA, GA 31602-1858
(229) 242-3060
(292) 242-9914
Mailing address
212 NORTHSIDE DR, VALDOSTA, GA 31602-1858
(229) 242-3040
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
PHRE008040
GA
3336H0001X
Home Infusion Therapy Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019860
PK
—
05
—
323764040A
—
GA
Enumeration date
08/04/2006
Last updated
11/04/2022
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