Provider Demographics
NPI:1437542537
Name:VITAL CARE OF MISS-LOU, INC.
Entity Type:Organization
Organization Name:VITAL CARE OF MISS-LOU, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAIER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-757-8711
Mailing Address - Street 1:PO BOX 1757
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-1757
Mailing Address - Country:US
Mailing Address - Phone:318-757-8711
Mailing Address - Fax:318-757-8716
Practice Address - Street 1:131 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2251
Practice Address - Country:US
Practice Address - Phone:318-757-8711
Practice Address - Fax:318-757-8716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY007013IR332B00000X, 332BP3500X, 3336C0003X, 3336C0004X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2200551Medicaid
LA2200551Medicaid