Provider Demographics
NPI:1518939396
Name:VERMILLION INC
Entity Type:Organization
Organization Name:VERMILLION INC
Other - Org Name:FITTINGS UNLIMITED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-727-1406
Mailing Address - Street 1:2795 100TH STREET
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322
Mailing Address - Country:US
Mailing Address - Phone:515-727-1406
Mailing Address - Fax:515-727-1409
Practice Address - Street 1:2795 100TH STREET
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322
Practice Address - Country:US
Practice Address - Phone:515-727-1406
Practice Address - Fax:515-727-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0417741Medicaid
IA49821OtherBCBS OF IA
IA0417741Medicaid