MEDICARE: VITAL FOUNDATIONS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1205434297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL FOUNDATIONS

Provider Business Mailing Address
First Line	:	PO BOX 146
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-0146
Country	:	US
Telephone Number	:	682-233-2336
Fax Number	:

Provider Business Practice Location Address
First Line	:	8637 TRIBUTE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-3385
Country	:	US
Telephone Number	:	682-233-2336
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHRISTOPHER BRAMICH
Credential	:	MS, CNS
Telephone Number	:	682-233-2336

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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Directions to “VITAL FOUNDATIONS ” Practice Location

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