Provider Demographics
NPI:1275181331
Name:FAIRBURN MEDICAL PRODUCTS, LLC
Entity Type:Organization
Organization Name:FAIRBURN MEDICAL PRODUCTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:FAIRBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-356-4639
Mailing Address - Street 1:5681 AL HIGHWAY 69S
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057
Mailing Address - Country:US
Mailing Address - Phone:855-721-7233
Mailing Address - Fax:855-721-7234
Practice Address - Street 1:4306 RHODA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4136
Practice Address - Country:US
Practice Address - Phone:855-721-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-30
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADME001035OtherLOUISIANA BOARD OF PHARMACY REGISTRATION
3011895773OtherFDA REGISTRATION