Provider Demographics
NPI:1578650115
Name:VITAL CARE HOME MEDICAL EQUIP INC
Entity Type:Organization
Organization Name:VITAL CARE HOME MEDICAL EQUIP INC
Other - Org Name:MCLAREN HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-627-2031
Mailing Address - Street 1:761 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-2117
Mailing Address - Country:US
Mailing Address - Phone:231-627-7157
Mailing Address - Fax:231-597-8202
Practice Address - Street 1:829 W MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1998
Practice Address - Country:US
Practice Address - Phone:231-627-7157
Practice Address - Fax:231-597-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1319OtherBLUE CARE NETWORK
MI1758504Medicaid
MI540F903420OtherBLUE CROSS BLUE SHIELD
MI56737OtherNORTHWOOD NPN
MI1319OtherBLUE CARE NETWORK