Healthcare Provider Details

I. General information

NPI: 1093301418
Provider Name (Legal Business Name): VITAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NW 12TH AVE STE 107
BATTLE GROUND WA
98604-9141
US

IV. Provider business mailing address

PO BOX 1183
BATTLE GROUND WA
98604-1183
US

V. Phone/Fax

Practice location:
  • Phone: 360-723-0528
  • Fax:
Mailing address:
  • Phone: 360-723-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER COBB
Title or Position: BILLING/CREDENTIALING MANAGER
Credential:
Phone: 360-723-0528