Provider Demographics
NPI:1134132335
Name:SARTIN'S VITAL CARE INC
Entity Type:Organization
Organization Name:SARTIN'S VITAL CARE INC
Other - Org Name:SARTIN'S VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:
Authorized Official - Last Name:SARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-864-7056
Mailing Address - Street 1:PO BOX 5047
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 15TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2524
Practice Address - Country:US
Practice Address - Phone:228-864-7056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01681/01.13336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040011Medicaid
MS606520OtherTRIGON BCBS
AL73012424OtherBCBS
MS00034748Medicaid
LA53025OtherBCBS HIT
=========OtherCHAMPUS TRICARE
MS00034748Medicaid
MS606520OtherTRIGON BCBS
MS00034748Medicaid