Organization
COMPLETE VITAL CARE, INC.
Active
Organization
COMPLETE VITAL CARE, INC.
Active
Other names
Complete Vital Care, Shreveport
Organization subpart
No
Provider details
NPI number
Authorized official
TED GARDINER (PRESIDENT)
(318) 686-9995
Entity
Organization
Contact information
Practice address
2530 BERT KOUNS INDUSTRIAL LOOP, SUITE 116, SHREVEPORT, LA 71118-3132
(318) 686-9995
(318) 686-9997
Mailing address
411 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7229
(318) 747-9977
(318) 747-9994
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
4863-IR
LA
332BC3200X
Customized Equipment (DME)
4863-IR
LA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
4863-IR
LA
332BX2000X
Oxygen Equipment & Supplies (DME)
4863-IR
LA
333600000X
Pharmacy
4863-IR
LA
3336C0003X
Community/Retail Pharmacy
4863-IR
LA
3336H0001X
Home Infusion Therapy Pharmacy
4863-IR
LA
3336L0003X
Long Term Care Pharmacy
4863-IR
LA
3336M0002X
Mail Order Pharmacy
4863-IR
LA
3336S0011X
Specialty Pharmacy
4863-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275247
—
LA
Enumeration date
07/05/2006
Last updated
04/20/2008
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