Provider Demographics
NPI:1932137528
Name:VANTIL MEDICAL INC
Entity Type:Organization
Organization Name:VANTIL MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:S
Authorized Official - Last Name:VANTIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-926-5400
Mailing Address - Street 1:320 S CALUMET RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2451
Mailing Address - Country:US
Mailing Address - Phone:219-926-5400
Mailing Address - Fax:219-926-3400
Practice Address - Street 1:320 S CALUMET RD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2451
Practice Address - Country:US
Practice Address - Phone:219-926-5400
Practice Address - Fax:219-926-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0107991527332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5060300001Medicare NSC