Provider Demographics
NPI:1194736249
Name:SOILEAU'S VITAL CARE, INC.
Entity type:Organization
Organization Name:SOILEAU'S VITAL CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:K
Authorized Official - Middle Name:
Authorized Official - Last Name:SOILEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-766-7453
Mailing Address - Street 1:PO BOX 5047
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7612 PICARDY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4353
Practice Address - Country:US
Practice Address - Phone:225-766-7453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2491-IR3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1259993Medicaid
LA=========0OtherBCBS HIT
=========002OtherTRICARE CSP
LA=========AOtherBCBS DME
LA1259993Medicaid
LA=========AOtherBCBS DME