Provider Demographics
NPI:1194986596
Name:VITAL CARE ONE, LLC.
Entity type:Organization
Organization Name:VITAL CARE ONE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-295-6190
Mailing Address - Street 1:125 MEROVAN DR STE 1
Mailing Address - Street 2:P.O. BOX 6099
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-8645
Mailing Address - Country:US
Mailing Address - Phone:803-426-8052
Mailing Address - Fax:
Practice Address - Street 1:125 MEROVAN DR STE 1
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-8645
Practice Address - Country:US
Practice Address - Phone:803-426-8052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA007400300AMedicaid
SCAB0273Medicaid
GA202G593729Medicare PIN
SCAB0273Medicaid