Healthcare Provider Details

I. General information

NPI: 1396251542
Provider Name (Legal Business Name): 1ST AMERICA INFUSION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OXMOOR BLVD STE 100
BIRMINGHAM AL
35209
US

IV. Provider business mailing address

623 HIGHLAND COLONY PKWY STE 100
RIDGELAND MS
39157-6077
US

V. Phone/Fax

Practice location:
  • Phone: 601-988-1700
  • Fax:
Mailing address:
  • Phone: 601-988-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SIMON CASTELLANOS
Title or Position: CEO
Credential:
Phone: 601-988-1700