Provider Demographics
NPI:1356422141
Name:VAN'S MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:VAN'S MEDICAL EQUIPMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANANTWERP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-369-7456
Mailing Address - Street 1:2547 M 139
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-6413
Mailing Address - Country:US
Mailing Address - Phone:269-927-8635
Mailing Address - Fax:269-925-4167
Practice Address - Street 1:2547 M 139
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6413
Practice Address - Country:US
Practice Address - Phone:269-927-8635
Practice Address - Fax:269-925-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI87-4800862Medicaid
MI87-4800862Medicaid