Provider Demographics
NPI:1053109710
Name:VITALMEDIX SUPPLIES LLC
Entity type:Organization
Organization Name:VITALMEDIX SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UNKNOWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED MOHIUDDIN AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-331-8174
Mailing Address - Street 1:10616 E 18TH ST S STE 402
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052-2203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10616 E WINNER RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052-2203
Practice Address - Country:US
Practice Address - Phone:872-331-8174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITALMEDIX SUPPLIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory