MEDICARE: VITAL EAGLES HEALTH CARE INC

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	342000000X	Transportation Network Company
2	208D00000X	General Practice 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	:	1225610967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL EAGLES HEALTH CARE INC

Provider Business Mailing Address
First Line	:	13021 W LINEBAUGH AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-4509
Country	:	US
Telephone Number	:	813-709-8567
Fax Number	:	215-642-8552

Provider Business Practice Location Address
First Line	:	13021 W LINEBAUGH AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-4509
Country	:	US
Telephone Number	:	813-709-8567
Fax Number	:	215-642-8552

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	ARLENIA PAULINO
Credential	:	AUTHORIZED SIGNER
Telephone Number	:	215-205-2229

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	02/16/2024

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