Provider Demographics
NPI:1730448275
Name:VIVA MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:VIVA MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EFREM
Authorized Official - Middle Name:
Authorized Official - Last Name:COLMENERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-861-1000
Mailing Address - Street 1:8150 N CENTRAL EXPY
Mailing Address - Street 2:780
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8150 N CENTRAL EXPY
Practice Address - Street 2:780
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1815
Practice Address - Country:US
Practice Address - Phone:972-861-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies