Provider Demographics
NPI:1023506466
Name:VAST DURABLE MEDICAL EQUIPMENT INC
Entity type:Organization
Organization Name:VAST DURABLE MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-741-7023
Mailing Address - Street 1:2985 S MERIDIAN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7961
Mailing Address - Country:US
Mailing Address - Phone:208-860-2849
Mailing Address - Fax:
Practice Address - Street 1:2985 S MERIDIAN RD STE 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7961
Practice Address - Country:US
Practice Address - Phone:208-860-2849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1376707034OtherNPI