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General NPI Number Information
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NPI Number | 1023506466
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Entity Type | Organization
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Legal Business Name | VAST DURABLE MEDICAL EQUIPMENT INC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 2985 S MERIDIAN RD STE 140
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City | MERIDIAN
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State | ID
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Zip | 83642-7961
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Country | US
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Telephone | 208-860-2849
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Fax |
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Provider Business Mailing Address
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Address Line | 2985 S MERIDIAN RD STE 140
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City | MERIDIAN
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State | ID
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Zip | 83642-7961
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Country | US
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Telephone | 208-860-2849
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RYAN DANIEL BIAS
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Credential | DC
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Telephone | 951-741-7023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O-0583
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License Number State | ID
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