MEDICARE: VITALEDGE DIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1366330201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALEDGE DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	4099 MCEWEN RD STE 132
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5023
Country	:	US
Telephone Number	:	214-845-6955
Fax Number	:

Provider Business Practice Location Address
First Line	:	4099 MCEWEN RD STE 132
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5023
Country	:	US
Telephone Number	:	214-845-6955
Fax Number	:	214-845-6955

Authorized Official
Title or Position	:	OWNER
Name	:	MONIL PAREKH
Credential	:
Telephone Number	:	609-410-9998

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	02/27/2026

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