Provider Demographics
NPI:1588849145
Name:IV CARE INC
Entity Type:Organization
Organization Name:IV CARE INC
Other - Org Name:TYSON HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-252-6179
Mailing Address - Street 1:530 JM ASH DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635
Mailing Address - Country:US
Mailing Address - Phone:662-252-2446
Mailing Address - Fax:662-252-4379
Practice Address - Street 1:149 A SOUTH MARKET STREET
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-3238
Practice Address - Country:US
Practice Address - Phone:662-252-3688
Practice Address - Fax:662-252-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06294183500000X
MS07543/11.1332BX2000X
MS07543-11-1333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03186562Medicaid
MS03186562Medicaid