Provider Demographics
NPI:1962823054
Name:VENDOR PRO CORPORATION
Entity Type:Organization
Organization Name:VENDOR PRO CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-219-1922
Mailing Address - Street 1:1627 W MAIN ST.
Mailing Address - Street 2:SUITE 446
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4011
Mailing Address - Country:US
Mailing Address - Phone:406-219-1922
Mailing Address - Fax:406-219-1953
Practice Address - Street 1:1627 W MAIN ST.
Practice Address - Street 2:SUITE 446
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4011
Practice Address - Country:US
Practice Address - Phone:406-219-1922
Practice Address - Fax:406-219-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MTPHA-WDD-LIC-21852333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy