Provider Demographics
NPI:1659619435
Name:VANGUARD MEDICAL EQUIPMENT, CORP.
Entity Type:Organization
Organization Name:VANGUARD MEDICAL EQUIPMENT, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT
Authorized Official - Phone:305-231-8227
Mailing Address - Street 1:1275 W 47TH PL STE 437
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3454
Mailing Address - Country:US
Mailing Address - Phone:305-231-8227
Mailing Address - Fax:786-522-9050
Practice Address - Street 1:1275 W 47TH PL STE 437
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3454
Practice Address - Country:US
Practice Address - Phone:305-231-8227
Practice Address - Fax:786-522-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313788332B00000X
FL326883332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6729280001Medicare NSC