=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245193507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITAL GUARD TESTING & COMPLIANCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 W MAIN STREET
-----------------------------------------------------
City | MORVEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-419-9685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 142
-----------------------------------------------------
City | CHESTERFEILD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-878-1437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | O/O
-----------------------------------------------------
Name | TONI ANNETTE BUTLER WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-878-1437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------