Healthcare Provider Details

I. General information

NPI: 1639171937
Provider Name (Legal Business Name): VANTAGE DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 SOUTH HERMITAGE ROAD
HERMITAGE PA
16148-0000
US

IV. Provider business mailing address

PO BOX 1449
MEADVILLE PA
16335-0949
US

V. Phone/Fax

Practice location:
  • Phone: 724-346-4640
  • Fax: 724-346-4645
Mailing address:
  • Phone: 814-337-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHELLE KASTE
Title or Position: CFO
Credential:
Phone: 814-337-0000