Provider Demographics
NPI:1164038709
Name:VITAL MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:VITAL MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:G
Authorized Official - Last Name:GHAZALPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:AHSC, CHS, COE, RPT
Authorized Official - Phone:818-905-1700
Mailing Address - Street 1:700 N BRAND BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3235
Mailing Address - Country:US
Mailing Address - Phone:818-905-1700
Mailing Address - Fax:
Practice Address - Street 1:700 N BRAND BLVD STE 220
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3235
Practice Address - Country:US
Practice Address - Phone:818-905-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty