Provider Demographics
NPI:1194458760
Name:VITALEXAM LLC
Entity Type:Organization
Organization Name:VITALEXAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:J
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP FNP-BC AGACNP-BC
Authorized Official - Phone:888-850-3926
Mailing Address - Street 1:945 W MICHIGAN AVE STE 10B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-2301
Mailing Address - Country:US
Mailing Address - Phone:888-850-3926
Mailing Address - Fax:
Practice Address - Street 1:945 W MICHIGAN AVE STE 10B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-2301
Practice Address - Country:US
Practice Address - Phone:888-850-3926
Practice Address - Fax:850-429-4313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine