Provider Demographics
NPI:1548251739
Name:AMBULATORY INFUSION CARE, INC
Entity type:Organization
Organization Name:AMBULATORY INFUSION CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR/AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH, JD
Authorized Official - Phone:989-621-1534
Mailing Address - Street 1:121 E BROADWAY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2360
Mailing Address - Country:US
Mailing Address - Phone:989-773-4879
Mailing Address - Fax:989-772-7490
Practice Address - Street 1:920 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4648
Practice Address - Country:US
Practice Address - Phone:989-772-7770
Practice Address - Fax:989-772-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 3336H0001X
MI5301005525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2640581Medicaid
MIOC70260OtherBSBCM
MIOC700010OtherBCBSM HIT
OC700010OtherBCBSMHIT
MI2640581Medicaid