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General NPI Number Information
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NPI Number | 1306750302
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Entity Type | Organization
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Legal Business Name | VITALPATH MEDICAL
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 15550 KINGFIELD DR APT 1204
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City | HOUSTON
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State | TX
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Zip | 77084-6269
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Country | US
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Telephone | 945-206-0473
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANGER
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Name | KEVIN GRUBB
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Credential |
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Telephone | 945-206-0473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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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 | NULL
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Taxonomy #3
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | NULL
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