Provider Demographics
NPI:1417605478
Name:VITALSFUSION URGENT CARE PLLC
Entity Type:Organization
Organization Name:VITALSFUSION URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAKHRUDIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-710-8081
Mailing Address - Street 1:940 W STACY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5215
Mailing Address - Country:US
Mailing Address - Phone:773-710-8081
Mailing Address - Fax:
Practice Address - Street 1:940 W STACY RD STE 110
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5215
Practice Address - Country:US
Practice Address - Phone:773-710-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care