Organization
TWIN STATES VITAL CARE, INC.
Active
Other names
Medicine Mart Vital Care
Organization subpart
No
Provider details
NPI number
Authorized official
STERLING GRADY KOONCE (MANAGER)
(910) 653-6169
Entity
Organization
Contact information
Practice address
218B S MAIN ST, TABOR CITY, NC 28463-1904
(910) 653-6169
(910) 653-6078
Mailing address
PO BOX 5047, MERIDIAN, MS 39302-5047
(800) 447-4095
(601) 482-7490
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
2627-IR
LA
332BC3200X
Customized Equipment (DME)
2627-IR
LA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
2627-IR
LA
332BX2000X
Oxygen Equipment & Supplies (DME)
2627-IR
LA
333600000X
Pharmacy
2627-IR
LA
3336C0003X
Community/Retail Pharmacy
2627-IR
LA
3336H0001X
Home Infusion Therapy Pharmacy
2627-IR
LA
3336L0003X
Long Term Care Pharmacy
2627-IR
LA
3336M0002X
Mail Order Pharmacy
2627-IR
LA
3336S0011X
Specialty Pharmacy
Primary
2627-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0245837
—
NC
05
—
6800472
—
NC
05
—
7703531
—
NC
05
—
7N7828
—
SC
05
—
DE2065
—
SC
Enumeration date
08/22/2006
Last updated
09/11/2025
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