Provider Demographics
NPI:1760765721
Name:VITAL SURGICAL SOLUTIONS
Entity Type:Organization
Organization Name:VITAL SURGICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-212-2123
Mailing Address - Street 1:2349 WAYFARER DR
Mailing Address - Street 2:
Mailing Address - City:DISCOVERY BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94505-9225
Mailing Address - Country:US
Mailing Address - Phone:831-212-2123
Mailing Address - Fax:
Practice Address - Street 1:2848 MARIPOSA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1308
Practice Address - Country:US
Practice Address - Phone:831-212-2123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical