1598778797 NPI number — SARTIN'S VITAL CARE INC

Table of content: (NPI 1598778797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598778797 NPI number — SARTIN'S VITAL CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARTIN'S VITAL CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SARTIN'S VITAL CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598778797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39302-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 15TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39501-2524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-864-7056
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SARTIN
Authorized Official First Name:
C
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
228-864-7056

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X , with the licence number:  01681/01.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 73012424 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 00040011 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 606520 . This is a "TRIGON BCBS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00034748 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53025 . This is a "BCBS HIT" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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