MEDICARE: VITAL CARE HOME MEDICAL EQUIP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	56741	OTHER	MI	NORTHWOOD NPN
3	1318	OTHER	MI	BLUE CARE NETWORK
4	540F903420	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1073585816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL CARE HOME MEDICAL EQUIP INC

Provider Business Mailing Address
First Line	:	761 LAFAYETTE AVE
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-2117
Country	:	US
Telephone Number	:	231-627-7157
Fax Number	:	231-597-8202

Provider Business Practice Location Address
First Line	:	994 S MAIN ST
Second Line	:	SUITE A
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-2265
Country	:	US
Telephone Number	:	231-627-7157
Fax Number	:	231-597-8202

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	JULIE BRYAN
Credential	:
Telephone Number	:	231-627-2031

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	12/19/2017

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