Provider Demographics
NPI:1649361718
Name:VANBOB, INC.
Entity type:Organization
Organization Name:VANBOB, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARVIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HERBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:830-372-3838
Mailing Address - Street 1:519 N KING ST
Mailing Address - Street 2:# 108
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-4866
Mailing Address - Country:US
Mailing Address - Phone:830-372-3838
Mailing Address - Fax:830-372-1345
Practice Address - Street 1:519 N KING ST
Practice Address - Street 2:# 108
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-4866
Practice Address - Country:US
Practice Address - Phone:830-372-3838
Practice Address - Fax:830-372-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0200920001Medicare ID - Type Unspecified