Healthcare Provider Details

I. General information

NPI: 1174693105
Provider Name (Legal Business Name): BURNHAM'S VITAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4931 MAIN ST # B
MOSS POINT MS
39563-2746
US

IV. Provider business mailing address

4931 MAIN ST # B
MOSS POINT MS
39563-2746
US

V. Phone/Fax

Practice location:
  • Phone: 228-474-4663
  • Fax: 228-474-7660
Mailing address:
  • Phone: 228-474-4663
  • Fax: 228-474-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number05113021
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number05113021
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number05113021
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05113021
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number05113021
License Number StateMS
# 7
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number05113021
License Number StateMS
# 8
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number05113021
License Number StateMS

VIII. Authorized Official

Name: ALVIN CRAIG SARTIN
Title or Position: PRESIDENT
Credential:
Phone: 228-474-4663