Organization Name: | VANS GROUP LLC |
NPI Number: | 1104136605 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | VENU POTLURI (MEMBER, PIC) |
Mailing Address: | 1059 E 9 Mile Rd Hazel Park |
State: | MI US |
Postal Code: | 480301855 |
Phone Number: | 2488507196 |
Fax Number: | 2488507081 |
NPI Enumeration Date: | 10/18/2010 |
NPI Last Update Date: | 04/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |