Provider Demographics
NPI:1164733564
Name:VITAL MEDICAL OXYGEN & SUPPLIES INC
Entity Type:Organization
Organization Name:VITAL MEDICAL OXYGEN & SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-699-9238
Mailing Address - Street 1:13781 ROSWELL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5456
Mailing Address - Country:US
Mailing Address - Phone:877-699-9238
Mailing Address - Fax:909-591-9900
Practice Address - Street 1:13781 ROSWELL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5475
Practice Address - Country:US
Practice Address - Phone:877-699-9238
Practice Address - Fax:909-591-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies