Provider Demographics
NPI:1710169677
Name:VAN'S-DASCO HOME MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:VAN'S-DASCO HOME MEDICAL EQUIPMENT, LLC
Other - Org Name:VAN'S MEDICAL EQUIPMENT OF LAKELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAZUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-901-2109
Mailing Address - Street 1:375 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-1400
Mailing Address - Country:US
Mailing Address - Phone:614-901-2226
Mailing Address - Fax:614-901-2228
Practice Address - Street 1:1088 MINERS RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9625
Practice Address - Country:US
Practice Address - Phone:269-927-8635
Practice Address - Fax:269-925-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710169677Medicaid
MI54-0-A1-1200-0OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI54-0-A1-1200-0OtherBLUE CROSS BLUE SHIELD OF MICHIGAN