Provider Demographics
NPI:1952604407
Name:VITAL MEDICAL SUPPLIES & HEALTH SOLUTIONS,LLC
Entity Type:Organization
Organization Name:VITAL MEDICAL SUPPLIES & HEALTH SOLUTIONS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-442-1233
Mailing Address - Street 1:240 DEVEREAUX DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3752
Mailing Address - Country:US
Mailing Address - Phone:601-442-1233
Mailing Address - Fax:601-442-1232
Practice Address - Street 1:240 DEVEREAUX DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3752
Practice Address - Country:US
Practice Address - Phone:601-442-1233
Practice Address - Fax:601-442-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11377332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies