Healthcare Provider Details

I. General information

NPI: 1609889807
Provider Name (Legal Business Name): SARTIN'S VITAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 15TH ST SUITE A
GULFPORT MS
39501-2524
US

IV. Provider business mailing address

PO BOX 5047
MERIDIAN MS
39302-5047
US

V. Phone/Fax

Practice location:
  • Phone: 228-864-7056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number01681/01.1
License Number StateMS

VIII. Authorized Official

Name: C SARTIN
Title or Position: OWNER
Credential:
Phone: 228-864-7056