1275181331 NPI number — FAIRBURN MEDICAL PRODUCTS, LLC

Table of content: (NPI 1275181331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275181331 NPI number — FAIRBURN MEDICAL PRODUCTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRBURN MEDICAL PRODUCTS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275181331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5681 AL HIGHWAY 69 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CULLMAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35057-4225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-721-7233
Provider Business Mailing Address Fax Number:
855-721-7234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9323 MAMMOTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70814-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-721-7233
Provider Business Practice Location Address Fax Number:
855-721-7234
Provider Enumeration Date:
08/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
FAIRBURN
Authorized Official First Name:
CHERIE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
205-356-4639

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DME001035 . This is a "LOUISIANA BOARD OF PHARMACY REGISTRATION" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 3011895773 . This is a "FDA REGISTRATION" identifier . This identifiers is of the category "OTHER".




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