Healthcare Provider Details

I. General information

NPI: 1043238694
Provider Name (Legal Business Name): COMPLETE VITAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 DIXIE PLZ STE B
NATCHITOCHES LA
71457-5880
US

IV. Provider business mailing address

PO BOX 5047
MERIDIAN MS
39302-5047
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-2461
  • Fax: 318-357-0778
Mailing address:
  • Phone: 800-447-4095
  • Fax: 601-482-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3763-IR
License Number StateLA

VIII. Authorized Official

Name: GEORGE GARDINER
Title or Position: PRESIDENT
Credential:
Phone: 318-352-2461