Provider Demographics
NPI:1225610967
Name:VITAL EAGLES HEALTH CARE INC
Entity Type:Organization
Organization Name:VITAL EAGLES HEALTH CARE INC
Other - Org Name:VITAL EAGLES HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARLENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULINO
Authorized Official - Suffix:
Authorized Official - Credentials:AUTHORIZED SIGNER
Authorized Official - Phone:215-205-2229
Mailing Address - Street 1:13021 W LINEBAUGH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4509
Mailing Address - Country:US
Mailing Address - Phone:813-709-8567
Mailing Address - Fax:215-642-8552
Practice Address - Street 1:13021 W LINEBAUGH AVE STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4509
Practice Address - Country:US
Practice Address - Phone:813-709-8567
Practice Address - Fax:215-642-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No342000000XTransportation ServicesTransportation Network CompanyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty