Provider Demographics
NPI:1891789061
Name:VANN HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:VANN HEALTHCARE SERVICES INC
Other - Org Name:VANN HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-651-7627
Mailing Address - Street 1:212 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1122
Mailing Address - Country:US
Mailing Address - Phone:270-678-2350
Mailing Address - Fax:270-678-3350
Practice Address - Street 1:212 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1122
Practice Address - Country:US
Practice Address - Phone:270-678-2350
Practice Address - Fax:270-678-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332B00000X, 333600000X
KYP022093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90070053Medicaid
2031672OtherPK
KY54025770Medicaid