Provider Demographics
NPI:1578575379
Name:PHARMACY PLUS INFUSION SERVICES OF HATTIESBURG, INC.
Entity Type:Organization
Organization Name:PHARMACY PLUS INFUSION SERVICES OF HATTIESBURG, INC.
Other - Org Name:VITAL CARE INFUSION SERVICES OF HATTIESBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CPHT
Authorized Official - Phone:601-261-0503
Mailing Address - Street 1:163 TURTLE CREEK DR STE 130
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1268
Mailing Address - Country:US
Mailing Address - Phone:601-602-2238
Mailing Address - Fax:601-475-7840
Practice Address - Street 1:163 TURTLE CREEK DR STE 130
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1268
Practice Address - Country:US
Practice Address - Phone:601-261-0503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04427/02.0332B00000X, 332BP3500X, 333600000X, 3336C0003X, 3336H0001X, 3336L0003X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000030051OtherBCBS OF MS
MS00330185Medicaid
MS00440592Medicaid
MS00440592Medicaid
MS00440592Medicaid
P00106213Medicare ID - Type UnspecifiedRAILROAD
MS000030051OtherBCBS OF MS