Provider Demographics
NPI:1184626442
Name:VANTAGE DME PARTNERSHIP
Entity type:Organization
Organization Name:VANTAGE DME PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-337-0000
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-0949
Mailing Address - Country:US
Mailing Address - Phone:814-337-0000
Mailing Address - Fax:
Practice Address - Street 1:110 E SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2134
Practice Address - Country:US
Practice Address - Phone:814-723-4917
Practice Address - Fax:814-723-4919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VANTAGE DME PARTNERSHIP D/B/A VANTAGE HOME MEDICAL EQUIPMENT & SERVI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-01
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1103530005Medicare NSC