Healthcare Provider Details

I. General information

NPI: 1932133196
Provider Name (Legal Business Name): SARTIN'S VITAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 BROAD AVE
GULFPORT MS
39501
US

IV. Provider business mailing address

1311 BROAD AVE
GULFPORT MS
39501-2419
US

V. Phone/Fax

Practice location:
  • Phone: 228-864-7056
  • Fax: 228-864-2402
Mailing address:
  • Phone: 228-864-7056
  • Fax: 228-864-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number08961 1/2.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number08961/2.1
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number08961 1/2.1
License Number StateMS
# 6
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number08961 1/2.1
License Number StateMS

VIII. Authorized Official

Name: ALVIN SARTIN
Title or Position: PRES
Credential:
Phone: 228-864-7056