MEDICARE: VITALITY MEDICAL CENTER OF HOUSTON

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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1427337641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY MEDICAL CENTER OF HOUSTON

Provider Business Mailing Address
First Line	:	12310 AMANDA PINES DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-7002
Country	:	US
Telephone Number	:	832-328-7103
Fax Number	:

Provider Business Practice Location Address
First Line	:	457 UVALDE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3717
Country	:	US
Telephone Number	:	832-328-7103
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN FITZGERALD CHATMAN II
Credential	:
Telephone Number	:	832-207-4413

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	08/04/2011

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