Provider Demographics
NPI:1528641941
Name:PRIME VITALITY LLC
Entity type:Organization
Organization Name:PRIME VITALITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIV
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-852-1871
Mailing Address - Street 1:10007 HUEBNER RD STE 302
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1646
Mailing Address - Country:US
Mailing Address - Phone:210-837-3113
Mailing Address - Fax:210-761-6600
Practice Address - Street 1:10007 HUEBNER RD STE 302
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1646
Practice Address - Country:US
Practice Address - Phone:210-876-1635
Practice Address - Fax:210-761-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center