Provider Demographics
NPI:1861453896
Name:VICAN MEDICAL,INC.
Entity type:Organization
Organization Name:VICAN MEDICAL,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VITALIS
Authorized Official - Middle Name:CHINEDU
Authorized Official - Last Name:NWAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-306-1120
Mailing Address - Street 1:2323 S TROY ST
Mailing Address - Street 2:SUITE 3-105
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1946
Mailing Address - Country:US
Mailing Address - Phone:303-306-1120
Mailing Address - Fax:303-306-1134
Practice Address - Street 1:2323 S TROY ST
Practice Address - Street 2:SUITE 3-105
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1946
Practice Address - Country:US
Practice Address - Phone:303-306-1120
Practice Address - Fax:303-306-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332H00000XSuppliersEyewear Supplier
Not Answered335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64032736Medicaid
SC5462960001Medicare ID - Type Unspecified