MEDICARE: CAROLINA VITAL CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	HC1690	NC
2	332B00000X	Durable Medical Equipment & Medical Supplies	HC1690	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3413488	OTHER		NABP

General Provider Information

NPI Number	:	1306849609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA VITAL CARE, INC

Provider Business Mailing Address
First Line	:	PO BOX 684
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-0684
Country	:	US
Telephone Number	:	252-726-3556
Fax Number	:	252-726-4227

Provider Business Practice Location Address
First Line	:	3302 BRIDGES ST STE C
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3366
Country	:	US
Telephone Number	:	252-726-3556
Fax Number	:	252-726-3556

Authorized Official
Title or Position	:	CORPORATE MANAGER
Name	:	MR. JERRY A. STANLEY
Credential	:
Telephone Number	:	252-726-3556

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/24/2008

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Directions to “CAROLINA VITAL CARE, INC ” Practice Location

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