Provider Demographics
NPI:1477194363
Name:VITAL CARE CLINIC, LLC
Entity Type:Organization
Organization Name:VITAL CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ENLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-520-5260
Mailing Address - Street 1:6805 NE LOOP 820 STE 408
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6687
Mailing Address - Country:US
Mailing Address - Phone:817-520-5260
Mailing Address - Fax:817-520-5279
Practice Address - Street 1:6805 NE LOOP 820 STE 408
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180
Practice Address - Country:US
Practice Address - Phone:817-520-5260
Practice Address - Fax:817-520-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty