MEDICARE: VANTAGE DME PARTNERSHIP

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	332BX2000X	Oxygen Equipment & Supplies (DME)		PA

General Provider Information

NPI Number	:	1184626442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANTAGE DME PARTNERSHIP

Provider Business Mailing Address
First Line	:	PO BOX 1449
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-0949
Country	:	US
Telephone Number	:	814-337-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E SAINT CLAIR ST
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-2134
Country	:	US
Telephone Number	:	814-723-4917
Fax Number	:	814-723-4919

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. MICHAEL D MOSBACHER
Credential	:
Telephone Number	:	814-337-0000

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/02/2010

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Directions to “VANTAGE DME PARTNERSHIP ” Practice Location

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