Ptcoa Home Infusion Services LLC

Primary specialty

Home Infusion AgencyTaxonomy code 251F00000X

Legal business name

PTCOA HOME INFUSION SERVICES LLC

Practice address

108 N Shackleford Rd
Little Rock, AR 72211-2840

Phone

(844) 215-0731

Fax

(501) 404-7789

NPI assigned

Mar 1, 2021

Organization subpart

No

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

Authorized official

Name

Meraj Siddiqui, MD

Title

Owner

Phone

(501) 712-2571

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1614556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614556800000",
    "number": "1235723313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N SHACKLEFORD RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 N SHACKLEFORD RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112840",
            "telephone_number": "844-215-0731",
            "fax_number": "501-404-7789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PTCOA HOME INFUSION SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-01",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUI",
        "authorized_official_first_name": "MERAJ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-712-2571",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPPLIER MEDICAL EQUIPMENT LICENSE",
            "identifier": "MG01994",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://ptcoaclinic.prognocis.com/prognocis/aptaClinicIndex.html",
            "affiliation": "N",
            "address_1": "108 N Shackleford Rd",
            "city": "Little Rock",
            "state": "AR",
            "country_code": "US",
            "postal_code": "722112840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.