Advanced Infant Formulas LLC

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

Legal business name

ADVANCED INFANT FORMULAS LLC

Practice address

10 Circle C Rd
Fountain, CO 80817-3307

Phone

(719) 201-6231

Fax

(719) 392-4607

NPI assigned

Dec 10, 2007

Last updated

Dec 10, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Wallace Layne Sisler

Title

Partner

Phone

(719) 201-6231

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197244800000",
    "number": "1609059971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 CIRCLE C RD",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "808173307",
            "telephone_number": "719-201-6231",
            "fax_number": "719-392-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CIRCLE C RD",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "808173307",
            "telephone_number": "719-201-6231",
            "fax_number": "719-392-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED INFANT FORMULAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-10",
        "last_updated": "2007-12-10",
        "status": "A",
        "authorized_official_last_name": "SISLER",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "LAYNE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "719-201-6231",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Parenteral & Enteral Nutrition Supplies (DME) in Fountain, CO
• Providers in Fountain, CO by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2007; 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.