Provider Demographics
NPI:1790462794
Name:VITAE HEALTH CLINICAL SERVICES TENNESSEE PLLC
Entity Type:Organization
Organization Name:VITAE HEALTH CLINICAL SERVICES TENNESSEE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:224-777-8045
Mailing Address - Street 1:415 W GOLF ROD
Mailing Address - Street 2:STE 26
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:224-777-8045
Mailing Address - Fax:312-312-9575
Practice Address - Street 1:112 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1168
Practice Address - Country:US
Practice Address - Phone:615-735-0569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty