NPIMap

Organization Active NPI

Druid City Infusion

  • Home Infusion Therapy Pharmacy
  • Northport, AL
National Provider Identifier
1306277397
Registry record updated Jul 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
License
114274 Issued in AL
Legal business name
DRUID CITY INFUSION
Practice address
611 McFarland Blvd
Suite C
Northport, AL 35476-3333
Phone
(205) 409-9601
Fax
(205) 449-7509
NPI assigned
Dec 2, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Logan Davis, PHARMD
Title
Owner
Phone
(601) 482-7420

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 114274 AL
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 114274 AL
Pharmacy 333600000X 114274 AL
Home Infusion Therapy Pharmacy 3336H0001X 114274 AL Primary
Long Term Care Pharmacy 3336L0003X 114274 AL

Addresses

Primary practice location

611 McFarland Blvd
Suite C
Northport, AL 35476-3333

Mailing address

611 McFarland Blvd
Suite C
Northport, AL 35476-3333
Phone (205) 409-9601

Other identifiers 3

IdentifierTypeStateIssuer
511-50337OtherALBCBS AL
158481MedicaidAL
163996MedicaidAL

Other names 1

  • Druid City Vital Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140627000195 AL DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 9537384953 Practice locations: Northport, AL
O20150109000358 AL Part B Supplier - Pharmacy 9537384953 Practice locations: Northport, AL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member organizations 14

Organizations listed as members of this organization in the National Provider Directory.

View all 14

Locations

611 McFarland Blvd
Ste C
Northport, AL 35476
Phone (205) 409-9601

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594339200000",
    "number": "1306277397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 MCFARLAND BLVD",
            "address_2": "SUITE C",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354763333",
            "telephone_number": "205-409-9601",
            "fax_number": "205-449-7509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 MCFARLAND BLVD",
            "address_2": "SUITE C",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354763333",
            "telephone_number": "205-409-9601",
            "fax_number": "205-449-7509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRUID CITY INFUSION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-02",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LOGAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-482-7420",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AL",
            "license": "114274",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "AL",
            "license": "114274",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AL",
            "license": "114274",
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "AL",
            "license": "114274",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "AL",
            "license": "114274",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AL",
            "identifier": "511-50337",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158481",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163996",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Druid City Vital Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Druid City Vital Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Northport, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.