Provider Demographics
NPI:1912047440
Name:VANTAGE HEALTHCARE NETWORK
Entity Type:Organization
Organization Name:VANTAGE HEALTHCARE NETWORK
Other - Org Name:VANTAGE MOBILE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT OF MOBILE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-337-0000
Mailing Address - Street 1:18282 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-8378
Mailing Address - Country:US
Mailing Address - Phone:814-337-0000
Mailing Address - Fax:866-303-9031
Practice Address - Street 1:332 W 6TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2812
Practice Address - Country:US
Practice Address - Phone:814-337-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9541OtherNPI
PA9541OtherNPI