Healthcare Provider Details

I. General information

NPI: 1588711592
Provider Name (Legal Business Name): VITALANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W THOMAS RD STE 210
PHOENIX AZ
85013-4415
US

IV. Provider business mailing address

9305 E VIA DE VENTURA
SCOTTSDALE AZ
85258-3597
US

V. Phone/Fax

Practice location:
  • Phone: 623-487-6400
  • Fax: 602-279-8240
Mailing address:
  • Phone: 602-343-7092
  • Fax: 602-343-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BHAVI A SHAH
Title or Position: CHIEF LEGAL & RISK OFFICER
Credential:
Phone: 480-675-5653