Provider Demographics
NPI:1528641941
Name:VITALITY MEDICAL LLC
Entity type:Organization
Organization Name:VITALITY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:OZGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-441-2557
Mailing Address - Street 1:10300 HERITAGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3920
Mailing Address - Country:US
Mailing Address - Phone:210-341-1012
Mailing Address - Fax:210-349-7876
Practice Address - Street 1:10300 HERITAGE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3920
Practice Address - Country:US
Practice Address - Phone:210-341-1012
Practice Address - Fax:210-349-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center