Provider Demographics
NPI:1508626177
Name:VITAL PEAK MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:VITAL PEAK MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ATIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-340-7037
Mailing Address - Street 1:10000 N 31ST AVE STE 100-133
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9582
Mailing Address - Country:US
Mailing Address - Phone:951-651-8077
Mailing Address - Fax:
Practice Address - Street 1:10000 N 31ST AVE STE 100-133
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9582
Practice Address - Country:US
Practice Address - Phone:833-340-7037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies