MEDICARE: VITALITY CLINICAL ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	146L00000X	Paramedic
2	163WE0003X	Emergency Registered Nurse
3	163WH0200X	Home Health Registered Nurse
4	163WI0500X	Infusion Therapy Registered Nurse
5	251E00000X	Home Health Agency
6	251F00000X	Home Infusion Agency
7	253Z00000X	In Home Supportive Care Agency
8	363L00000X	Nurse Practitioner
9	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134920523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY CLINICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	102 VIRGINIA LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5636
Country	:	US
Telephone Number	:	256-714-5099
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 HILL HEDGE DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-1108
Country	:	US
Telephone Number	:	256-714-5099
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RAINE CODDINGTON
Credential	:
Telephone Number	:	256-714-5099

Provider Enumeration Date	:	03/21/2025
Last Update Date	:	03/21/2025

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Directions to “VITALITY CLINICAL ASSOCIATES LLC ” Practice Location

Language	Start Address	Practice Location

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