Provider Demographics
NPI:1518701572
Name:VITAPATH LLC
Entity type:Organization
Organization Name:VITAPATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-293-1700
Mailing Address - Street 1:1887 BUFFALO RUN
Mailing Address - Street 2:
Mailing Address - City:THAXTON
Mailing Address - State:VA
Mailing Address - Zip Code:24174-3349
Mailing Address - Country:US
Mailing Address - Phone:540-293-1700
Mailing Address - Fax:
Practice Address - Street 1:810 BLUE RIDGE AVE STE D
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2433
Practice Address - Country:US
Practice Address - Phone:540-293-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)