Provider Demographics
NPI:1720482789
Name:VITAL CARE OF SOUTHWEST VIRGINIA, INC.
Entity Type:Organization
Organization Name:VITAL CARE OF SOUTHWEST VIRGINIA, INC.
Other - Org Name:VITAL CARE OF SOUTHWEST VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-964-0555
Mailing Address - Street 1:305 OLD KENTUCKY TPKE
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-9401
Mailing Address - Country:US
Mailing Address - Phone:276-964-0555
Mailing Address - Fax:276-964-2999
Practice Address - Street 1:305 OLD KENTUCKY TPKE
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-9401
Practice Address - Country:US
Practice Address - Phone:276-964-0555
Practice Address - Fax:276-964-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201004074332B00000X, 332BP3500X, 333600000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy