MEDICARE: VANTAGE DME LLC

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
2	332BX2000X	Oxygen Equipment & Supplies (DME)		PA

General Provider Information

NPI Number	:	1295737567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANTAGE DME LLC

Provider Business Mailing Address
First Line	:	1305 S MAIN ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-3036
Country	:	US
Telephone Number	:	814-337-0000
Fax Number	:	814-336-4209

Provider Business Practice Location Address
First Line	:	602 W CENTRAL AVE
Second Line	:
City	:	TITUSVILLE
State	:	PA
Zip	:	16354-2152
Country	:	US
Telephone Number	:	814-677-5794
Fax Number	:	814-677-5798

Authorized Official
Title or Position	:	CFO
Name	:	MICHELLE KASTE
Credential	:
Telephone Number	:	814-337-0000

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	12/05/2024

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