1366703217 NPI number — VITAL MEDICAL SUPPLIES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366703217 NPI number — VITAL MEDICAL SUPPLIES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAL MEDICAL SUPPLIES INC.
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:
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:
1366703217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15340 JOG RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33446-2170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-865-2382
Provider Business Mailing Address Fax Number:
888-519-4236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15340 JOG ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FLORIDA
Provider Business Practice Location Address Postal Code:
33486
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
561-865-2382
Provider Business Practice Location Address Fax Number:
888-519-4236
Provider Enumeration Date:
06/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BENSON
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO, OFFICIAL
Authorized Official Telephone Number:
561-865-2382

Provider Taxonomy Codes

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

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





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