Twin States Vital Care, Inc.

Primary specialty

Specialty PharmacyTaxonomy code 3336S0011X

License

2627-IR Issued in LA

Legal business name

TWIN STATES VITAL CARE, INC.

Practice address

218B S Main St
Tabor City, NC 28463-1904

Phone

(910) 653-6169

Fax

(910) 653-6078

NPI assigned

Aug 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sterling Grady Koonce

Title

Manager

Phone

(910) 653-6169

Specialties & licenses 10

Addresses

Other identifiers 5

Other names 1

• Medicine Mart Vital Care Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1467568337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5047",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393025047",
            "telephone_number": "800-447-4095",
            "fax_number": "601-482-7490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218B S MAIN ST",
            "city": "TABOR CITY",
            "state": "NC",
            "postal_code": "284631904",
            "telephone_number": "910-653-6169",
            "fax_number": "910-653-6078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWIN STATES VITAL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "KOONCE",
        "authorized_official_first_name": "STERLING",
        "authorized_official_middle_name": "GRADY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "910-653-6169"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "LA",
            "license": "2627-IR",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "LA",
            "license": "2627-IR",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "LA",
            "license": "2627-IR",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "LA",
            "license": "2627-IR",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "2627-IR",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "2627-IR",
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "LA",
            "license": "2627-IR",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "LA",
            "license": "2627-IR",
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "LA",
            "license": "2627-IR",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "LA",
            "license": "2627-IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6800472",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7703531",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7N7828",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0245837",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE2065",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Mart Vital Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialty Pharmacy in Tabor City, NC
• Providers in Tabor City, NC by specialty
• Specialty Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.