Provider Demographics
NPI:1932133196
Name:SARTIN'S VITAL CARE, INC.
Entity Type:Organization
Organization Name:SARTIN'S VITAL CARE, INC.
Other - Org Name:SARTINS VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-864-7056
Mailing Address - Street 1:1311 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2419
Mailing Address - Country:US
Mailing Address - Phone:228-864-7056
Mailing Address - Fax:228-864-2402
Practice Address - Street 1:1311 BROAD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-864-7056
Practice Address - Fax:228-864-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08961 1/2.1332B00000X, 332BP3500X, 3336S0011X
333600000X, 3336H0001X
MS08961/2.13336C0003X
MS01681/01.13336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040011Medicaid
2132187OtherPK
2132187OtherPK
MS73012424OtherBCBS
MS00040011Medicaid
MS02136782Medicaid
MS000012100OtherBCBS OF MS
612113700OtherFECA-DME
2513186OtherNABP
MS606520OtherTRIGON BCBS
=========002OtherTRICARE CSP
MS6567890001Medicare NSC
=========002OtherCHAMPUS TRI-CARE
MS53025OtherBCBS-HIT
=========-002OtherTRICARE PRIME