Provider Demographics
NPI:1427051754
Name:VANTAGE DME LLC
Entity type:Organization
Organization Name:VANTAGE DME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KASTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-337-0000
Mailing Address - Street 1:1305 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3036
Mailing Address - Country:US
Mailing Address - Phone:814-337-0000
Mailing Address - Fax:
Practice Address - Street 1:19049 PARK AVENUE PLZ
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-4011
Practice Address - Country:US
Practice Address - Phone:814-724-7191
Practice Address - Fax:814-337-8641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VANTAGE DME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-31
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1103530001Medicare NSC