Healthcare Provider Details

I. General information

NPI: 1932133535
Provider Name (Legal Business Name): SANDERS VITAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 S MAIN ST
GREENVILLE MS
38701-7000
US

IV. Provider business mailing address

1427 S MAIN ST
GREENVILLE MS
38701-7000
US

V. Phone/Fax

Practice location:
  • Phone: 662-378-2060
  • Fax: 662-332-9966
Mailing address:
  • Phone: 662-378-2060
  • Fax: 662-332-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number01568011
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number01568011
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number01568011
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number01568011
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number01568011
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01568011
License Number StateMS
# 7
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number01568011
License Number StateMS
# 8
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number01568011
License Number StateMS
# 9
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number01568011
License Number StateMS
# 10
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number01568011
License Number StateMS
# 11
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number01568011
License Number StateMS
# 12
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01568011
License Number StateMS

VIII. Authorized Official

Name: WYNN SANDERS
Title or Position: PRESIDENT
Credential:
Phone: 662-378-2060