Provider Demographics
NPI:1093972952
Name:VINCENT'S INC.
Entity Type:Organization
Organization Name:VINCENT'S INC.
Other - Org Name:VINCENT'S FOOTWEAR & APPAREL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.PED
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:660-826-1789
Mailing Address - Street 1:3115 W BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2116
Mailing Address - Country:US
Mailing Address - Phone:660-826-1789
Mailing Address - Fax:660-826-8081
Practice Address - Street 1:3115 W BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2116
Practice Address - Country:US
Practice Address - Phone:660-826-1789
Practice Address - Fax:660-826-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5604530001Medicare NSC