MEDICARE: VITALIZE HEALTH 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1710540307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALIZE HEALTH LLC

Provider Business Mailing Address
First Line	:	2200 S 40TH ST STE 102
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-2424
Country	:	US
Telephone Number	:	402-239-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 S 40TH ST STE 102
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-2424
Country	:	US
Telephone Number	:	402-413-0717
Fax Number	:	402-951-9763

Authorized Official
Title or Position	:	MANAGER
Name	:	JAMES T STEWART
Credential	:
Telephone Number	:	402-239-2005

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	04/19/2024

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Directions to “VITALIZE HEALTH LLC ” Practice Location

Language	Start Address	Practice Location

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