Provider Demographics
NPI:1891317343
Name:BECKER, VINCENT ASTOR
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:ASTOR
Last Name:BECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNDRIDGE
Mailing Address - State:KS
Mailing Address - Zip Code:67107-7169
Mailing Address - Country:US
Mailing Address - Phone:623-692-6571
Mailing Address - Fax:
Practice Address - Street 1:801 S EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107-7169
Practice Address - Country:US
Practice Address - Phone:623-692-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies