1710169677 NPI number — VAN'S-DASCO HOME MEDICAL EQUIPMENT, LLC

Table of content: (NPI 1710169677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710169677 NPI number — VAN'S-DASCO HOME MEDICAL EQUIPMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VAN'S-DASCO HOME MEDICAL EQUIPMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710169677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
375 N WEST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43082-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-901-2226
Provider Business Mailing Address Fax Number:
614-901-2228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1088 MINERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49085-9625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-927-8635
Provider Business Practice Location Address Fax Number:
269-925-4167
Provider Enumeration Date:
12/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAZUR
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
614-203-3332

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 54-0-A1-1200-0 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1710169677 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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