Organization
VITAL CARE HOME INFUSION SERVICES, INC.
Active
Other names
VITAL CARE HOME INFUSION SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
EVANS RAY GLASGOW SR. (MANAGER)
(985) 748-9500
Entity
Organization
Contact information
Practice address
211 WALNUT ST, AMITE, LA 70422
(985) 748-9500
(985) 748-5766
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
3366-IR
LA
332BC3200X
Customized Equipment (DME)
3366-IR
LA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
3366-IR
LA
332BX2000X
Oxygen Equipment & Supplies (DME)
3366-IR
LA
333600000X
Pharmacy
3366-IR
LA
3336C0003X
Community/Retail Pharmacy
3366-IR
LA
3336H0001X
Home Infusion Therapy Pharmacy
Primary
3366-IR
LA
3336L0003X
Long Term Care Pharmacy
3366-IR
LA
3336M0002X
Mail Order Pharmacy
3366-IR
LA
3336S0011X
Specialty Pharmacy
3366-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001
CHAMPUS/TRICARE
LA
05
—
2200127
—
LA
Enumeration date
08/30/2006
Last updated
07/30/2010
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