Organization
TWIN STATES INFUSION, LLC
Active
Other names
North Mississippi Vital Care
Organization subpart
No
Provider details
NPI number
Authorized official
LOGAN E. DAVIS (OWNER)
(205) 409-9601
Entity
Organization
Contact information
Practice address
146 S THOMAS ST STE B, TUPELO, MS 38801-5328
(662) 260-3366
(662) 269-1568
Mailing address
146 S THOMAS ST STE B, TUPELO, MS 38801-5328
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17939
PHARMACY PERMIT
MS
Enumeration date
02/07/2020
Last updated
04/15/2020
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