Provider Demographics
NPI:1093301418
Name:VITAL CARE, PLLC
Entity Type:Organization
Organization Name:VITAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CICHOSZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:360-210-3044
Mailing Address - Street 1:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-1183
Mailing Address - Country:US
Mailing Address - Phone:360-723-0528
Mailing Address - Fax:
Practice Address - Street 1:101 NW 12TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9141
Practice Address - Country:US
Practice Address - Phone:360-723-0528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-19
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA60470619OtherWASHINGTON DEPARTMENT OF HEALTH