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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