Provider Demographics
NPI:1275520553
Name:VITAL PRODUCTS, INC
Entity Type:Organization
Organization Name:VITAL PRODUCTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:COCKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-463-4455
Mailing Address - Street 1:4332 N CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1514
Mailing Address - Country:US
Mailing Address - Phone:773-463-4455
Mailing Address - Fax:773-463-5099
Practice Address - Street 1:4332 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1514
Practice Address - Country:US
Practice Address - Phone:773-463-4455
Practice Address - Fax:773-463-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0192620001Medicare NSC