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General NPI Number Information
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NPI Number | 1174693105
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Entity Type | Organization
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Legal Business Name | BURNHAM'S VITAL CARE LLC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 4931 MAIN ST # B
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City | MOSS POINT
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State | MS
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Zip | 39563-2746
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Country | US
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Telephone | 228-474-4663
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Fax | 228-474-7660
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Provider Business Mailing Address
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Address Line | 4931 MAIN ST # B
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City | MOSS POINT
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State | MS
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Zip | 39563-2746
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Country | US
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Telephone | 228-474-4663
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Fax | 228-474-7660
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALVIN CRAIG SARTIN
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Credential |
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Telephone | 228-474-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 05113021
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 05113021
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 05113021
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 05113021
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License Number State | MS
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Taxonomy #5
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 05113021
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License Number State | MS
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Taxonomy #6
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 05113021
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License Number State | MS
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Taxonomy #7
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 05113021
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License Number State | MS
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