Provider Demographics
NPI:1861594616
Name:VTEC MEDICAL EQUPMENT DISTRIBUTIONS, INC.
Entity type:Organization
Organization Name:VTEC MEDICAL EQUPMENT DISTRIBUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:EKPO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:909-753-9106
Mailing Address - Street 1:1489 W HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-2833
Mailing Address - Country:US
Mailing Address - Phone:909-753-9106
Mailing Address - Fax:909-620-7492
Practice Address - Street 1:1489 W HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2833
Practice Address - Country:US
Practice Address - Phone:909-753-9106
Practice Address - Fax:909-620-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43294332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4697230001Medicare NSC