Healthcare Provider Details

I. General information

NPI: 1376821470
Provider Name (Legal Business Name): VITALCARE HOME MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

994 S MAIN ST
CHEBOYGAN MI
49721-2265
US

IV. Provider business mailing address

761 LAFAYETTE AVE
CHEBOYGAN MI
49721-2117
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-7157
  • Fax: 231-597-8202
Mailing address:
  • Phone: 231-627-7157
  • Fax: 231-597-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JULIE BRYAN
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 231-627-2031