Healthcare Provider Details

I. General information

NPI: 1710540307
Provider Name (Legal Business Name): VITALIZE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S 40TH ST STE 102
LINCOLN NE
68506-2424
US

IV. Provider business mailing address

2200 S 40TH ST STE 102
LINCOLN NE
68506-2424
US

V. Phone/Fax

Practice location:
  • Phone: 402-413-0717
  • Fax: 402-951-9763
Mailing address:
  • Phone: 402-239-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES T STEWART
Title or Position: MANAGER
Credential:
Phone: 402-239-2005