Provider Demographics
NPI:1003551052
Name:VITAL HEALTH LLC
Entity Type:Organization
Organization Name:VITAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPELLIS-FREYRE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:419-740-3022
Mailing Address - Street 1:111 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2811
Mailing Address - Country:US
Mailing Address - Phone:419-740-3022
Mailing Address - Fax:419-740-3033
Practice Address - Street 1:111 CLINTON ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2811
Practice Address - Country:US
Practice Address - Phone:419-740-3022
Practice Address - Fax:419-740-3033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITAL HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-04
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty