NPIMap

Organization Active NPI

Complete Vital Care, Inc.

Doing business as Complete Vital Care, Shreveport

  • Parenteral & Enteral Nutrition Supplies (DME)
  • Shreveport, LA
National Provider Identifier
1720018492
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X
License
4863-IR Issued in LA
Legal business name
COMPLETE VITAL CARE, INC.
Doing business as
Complete Vital Care, Shreveport
Practice address
2530 Bert Kouns Industrial Loop
Suite 116
Shreveport, LA 71118-3132
Phone
(318) 686-9995
Fax
(318) 686-9997
NPI assigned
Jul 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Ted Gardiner
Title
President
Phone
(318) 686-9995

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 4863-IR LA
Customized Equipment (DME) 332BC3200X 4863-IR LA
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 4863-IR LA Primary
Oxygen Equipment & Supplies (DME) 332BX2000X 4863-IR LA
Pharmacy 333600000X 4863-IR LA
Community/Retail Pharmacy 3336C0003X 4863-IR LA
Home Infusion Therapy Pharmacy 3336H0001X 4863-IR LA
Long Term Care Pharmacy 3336L0003X 4863-IR LA
Mail Order Pharmacy 3336M0002X 4863-IR LA
Specialty Pharmacy 3336S0011X 4863-IR LA

Addresses

Primary practice location

2530 Bert Kouns Industrial Loop
Suite 116
Shreveport, LA 71118-3132

Mailing address

411 Ashley Ridge Blvd
Shreveport, LA 71106-7229
Phone (318) 747-9977

Other identifiers 1

IdentifierTypeStateIssuer
1275247MedicaidLA

Other names 1

  • Complete Vital Care, Shreveport Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Complete Vital Care - Shreveport18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1720018492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 ASHLEY RIDGE BLVD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711067229",
            "telephone_number": "318-747-9977",
            "fax_number": "318-747-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 116",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183132",
            "telephone_number": "318-686-9995",
            "fax_number": "318-686-9997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE VITAL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "GARDINER",
        "authorized_official_first_name": "TED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-686-9995"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "LA",
            "license": "4863-IR",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "LA",
            "license": "4863-IR",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "LA",
            "license": "4863-IR",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "LA",
            "license": "4863-IR",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "4863-IR",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "4863-IR",
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "LA",
            "license": "4863-IR",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "LA",
            "license": "4863-IR",
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "LA",
            "license": "4863-IR",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "LA",
            "license": "4863-IR",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275247",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Complete Vital Care, Shreveport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.