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General NPI Number Information
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NPI Number | 1235080490
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Entity Type | Organization
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Legal Business Name | VITAL LIFE LAB SERVICES LLC
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Dates
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Enumeration Date | 02/04/2026
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 2501 CHATHAM RD STE N
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 309-309-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE N
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 309-309-3432
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ASELA MOYA
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Credential |
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Telephone | 309-309-3432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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