Provider Demographics
NPI:1821391723
Name:VIVERAE VITALS, INC.
Entity Type:Organization
Organization Name:VIVERAE VITALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIZZOLARA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH, MBA
Authorized Official - Phone:214-827-4400
Mailing Address - Street 1:10670 N CENTRAL EXPY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2144
Mailing Address - Country:US
Mailing Address - Phone:214-827-4400
Mailing Address - Fax:214-827-4417
Practice Address - Street 1:10670 N CENTRAL EXPY STE 700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2144
Practice Address - Country:US
Practice Address - Phone:214-827-4400
Practice Address - Fax:214-827-4417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIVERAE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health