Elite Infusion IV Hydration LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

ELITE INFUSION IV HYDRATION LLC

Practice address

6136 Walnut St
Philadelphia, PA 19139-3704

Phone

(267) 516-8048

NPI assigned

Mar 4, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shavon Parker, LPN

Title

Ceo

Phone

(267) 516-8048

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1063047587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6136 WALNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191393704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6136 WALNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191393704",
            "telephone_number": "267-516-8048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE INFUSION IV HYDRATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-04",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "SHAVON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "267-516-8048",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Infusion Therapy Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Infusion Therapy Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.