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General NPI Number Information
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NPI Number | 1710540307
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Entity Type | Organization
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Legal Business Name | VITALIZE HEALTH LLC
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 2200 S 40TH ST STE 102
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City | LINCOLN
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State | NE
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Zip | 68506-2424
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Country | US
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Telephone | 402-413-0717
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Fax | 402-951-9763
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Provider Business Mailing Address
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Address Line | 2200 S 40TH ST STE 102
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City | LINCOLN
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State | NE
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Zip | 68506-2424
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Country | US
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Telephone | 402-239-2005
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JAMES T STEWART
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Credential |
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Telephone | 402-239-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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