Healthcare Provider Details

I. General information

NPI: 1366703217
Provider Name (Legal Business Name): VITAL MEDICAL SUPPLIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15340 JOG ROAD SUITE 100
DELRAY BEACH FLORIDA
33486
UM

IV. Provider business mailing address

15340 JOG RD SUITE 100
DELRAY BEACH FL
33446-2170
US

V. Phone/Fax

Practice location:
  • Phone: 561-865-2382
  • Fax: 888-519-4236
Mailing address:
  • Phone: 561-865-2382
  • Fax: 888-519-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL BENSON
Title or Position: CEO, OFFICIAL
Credential:
Phone: 561-865-2382