MEDICARE: VT MEDICAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1063265965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VT MEDICAL CORP

Provider Business Mailing Address
First Line	:	775 SW SOUTH MACEDO BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-1806
Country	:	US
Telephone Number	:	772-812-4475
Fax Number	:

Provider Business Practice Location Address
First Line	:	775 SW SOUTH MACEDO BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-1806
Country	:	US
Telephone Number	:	772-812-4475
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SURESH SUKHRAJ
Credential	:
Telephone Number	:	772-812-4475

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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