=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316950512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARTIN'S VITAL CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4300 15TH ST SUITE A
-----------------------------------------------------
City | GULFPORT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39501-2524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-864-7056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5047
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39302-5047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | C SARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 228-864-7056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number | 01681/01.1
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------