Provider Demographics
NPI:1790079887
Name:VITAL HOUSECALL GROUP INC.
Entity Type:Organization
Organization Name:VITAL HOUSECALL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMARRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-841-3940
Mailing Address - Street 1:2617 BOLTON BOONE DR
Mailing Address - Street 2:STE. B
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2074
Mailing Address - Country:US
Mailing Address - Phone:972-709-1781
Mailing Address - Fax:972-709-7738
Practice Address - Street 1:2617 BOLTON BOONE DR
Practice Address - Street 2:STE. B
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2074
Practice Address - Country:US
Practice Address - Phone:972-709-1781
Practice Address - Fax:972-709-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6955208D00000X
TXG6995208D00000X
TXD6396208D00000X
TXF0773208D00000X
TXPA04648363A00000X
TXPA02941363A00000X
TXPA05315363A00000X
TXPA04634363A00000X
TX763184363L00000X
TX572451363L00000X
TX600761363LA2100X
TX633922363LF0000X
TX508116363LF0000X
TX649018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD75117Medicare UPIN
TXS80084Medicare UPIN
TXQ65135Medicare UPIN
TXC18105Medicare UPIN
TXC21376Medicare UPIN