Healthcare Provider Details

I. General information

NPI: 1790079887
Provider Name (Legal Business Name): VITAL HOUSECALL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 BOLTON BOONE DR STE. B
DESOTO TX
75115-2074
US

IV. Provider business mailing address

2617 BOLTON BOONE DR STE. B
DESOTO TX
75115-2074
US

V. Phone/Fax

Practice location:
  • Phone: 972-709-1781
  • Fax: 972-709-7738
Mailing address:
  • Phone: 972-709-1781
  • Fax: 972-709-7738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG6955
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG6995
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD6396
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberF0773
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02941
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05315
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04634
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number763184
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number572451
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number600761
License Number StateTX
# 11
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number633922
License Number StateTX
# 12
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number508116
License Number StateTX
# 13
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number649018
License Number StateTX
# 14
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04648
License Number StateTX

VIII. Authorized Official

Name: MR. NICHOLAS LAMARRE
Title or Position: OWNER
Credential:
Phone: 972-841-3940