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General NPI Number Information
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NPI Number | 1134920523
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Entity Type | Organization
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Legal Business Name | VITALITY CLINICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 3001 HILL HEDGE DR
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City | MONTGOMERY
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State | AL
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Zip | 36111-1108
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Country | US
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Telephone | 256-714-5099
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Fax |
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Provider Business Mailing Address
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Address Line | 102 VIRGINIA LN
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City | ARLINGTON
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State | TX
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Zip | 76010-5636
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Country | US
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Telephone | 256-714-5099
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAINE CODDINGTON
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Credential |
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Telephone | 256-714-5099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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