=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306489323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITALANT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2019
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 N CRAIG ST
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15213-1567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-209-7456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 875 GREENTREE RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15220-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-209-7456
-----------------------------------------------------
Fax | 412-209-7095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF LEGAL & RISK OFFICER
-----------------------------------------------------
Name | BHAVI A SHAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-675-5653
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------