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General NPI Number Information
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NPI Number | 1205806114
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Entity Type | Organization
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Legal Business Name | VITAL DME, INC.
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 59 5TH ST
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City | GRETNA
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State | LA
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Zip | 70053-4744
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Country | US
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Telephone | 504-263-0865
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Fax | 504-263-0866
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Provider Business Mailing Address
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Address Line | PO BOX 8832
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City | METAIRIE
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State | LA
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Zip | 70011
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Country | US
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Telephone | 504-835-4000
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Fax | 504-835-4999
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Authorized Official
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Title or Position | CEO
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Name | MR. CARL D CLARK
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Credential | CPA
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Telephone | 504-835-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 260011299
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License Number State | LA
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