Provider Demographics
NPI:1902818156
Name:VINITA MEDICAL EQUIPMENT & SUPPLIES
Entity Type:Organization
Organization Name:VINITA MEDICAL EQUIPMENT & SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-323-0441
Mailing Address - Street 1:405 NORTH WILSON
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-4245
Mailing Address - Country:US
Mailing Address - Phone:918-323-0441
Mailing Address - Fax:918-323-0442
Practice Address - Street 1:405 N WILSON ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-2432
Practice Address - Country:US
Practice Address - Phone:918-323-0441
Practice Address - Fax:918-323-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1400812990AMedicaid
OK1400812990AMedicaid