Provider Demographics
NPI:1366703217
Name:VITAL MEDICAL SUPPLIES INC.
Entity type:Organization
Organization Name:VITAL MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-865-2382
Mailing Address - Street 1:15340 JOG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2170
Mailing Address - Country:US
Mailing Address - Phone:561-865-2382
Mailing Address - Fax:888-519-4236
Practice Address - Street 1:15340 JOG ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:DELRAY BEACH
Practice Address - State:FLORIDA
Practice Address - Zip Code:33486
Practice Address - Country:UM
Practice Address - Phone:561-865-2382
Practice Address - Fax:888-519-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies