Provider Demographics
NPI:1467812396
Name:VITAL IOM LLC
Entity Type:Organization
Organization Name:VITAL IOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-733-9955
Mailing Address - Street 1:17194 PRESTON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1203
Mailing Address - Country:US
Mailing Address - Phone:972-733-9955
Mailing Address - Fax:972-733-9935
Practice Address - Street 1:17194 PRESTON RD STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1203
Practice Address - Country:US
Practice Address - Phone:972-733-9955
Practice Address - Fax:972-733-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty