Provider Demographics
NPI:1811592546
Name:BUSTIN & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BUSTIN & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-9045
Mailing Address - Street 1:111 S 40TH AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1602
Mailing Address - Country:US
Mailing Address - Phone:601-909-0409
Mailing Address - Fax:601-909-0499
Practice Address - Street 1:111 S 40TH AVE STE 20
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1602
Practice Address - Country:US
Practice Address - Phone:601-909-0409
Practice Address - Fax:601-909-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care