Healthcare Provider Details

I. General information

NPI: 1427001585
Provider Name (Legal Business Name): VANTAGE DME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 PORTERSVILLE RD
ELLWOOD CITY PA
16117-2431
US

IV. Provider business mailing address

229 PORTERSVILLE RD
ELLWOOD CITY PA
16117-2431
US

V. Phone/Fax

Practice location:
  • Phone: 724-752-1562
  • Fax: 724-752-1564
Mailing address:
  • Phone: 724-752-1562
  • Fax: 724-752-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: CINDY LOU BERKOBEN
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 800-548-5463