Healthcare Provider Details

I. General information

NPI: 1306849609
Provider Name (Legal Business Name): CAROLINA VITAL CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 BRIDGES ST STE C
MOREHEAD CITY NC
28557-3366
US

IV. Provider business mailing address

PO BOX 684
MOREHEAD CITY NC
28557-0684
US

V. Phone/Fax

Practice location:
  • Phone: 252-726-3556
  • Fax: 252-726-3556
Mailing address:
  • Phone: 252-726-3556
  • Fax: 252-726-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHC1690
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberHC1690
License Number StateNC

VIII. Authorized Official

Name: MR. JERRY A. STANLEY
Title or Position: CORPORATE MANAGER
Credential:
Phone: 252-726-3556