Provider Demographics
NPI:1942617071
Name:VITALISTICS, LLC
Entity Type:Organization
Organization Name:VITALISTICS, LLC
Other - Org Name:VITALISTICS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:844-550-9970
Mailing Address - Street 1:5930 E PIMA ST
Mailing Address - Street 2:#232
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4370
Mailing Address - Country:US
Mailing Address - Phone:844-550-9970
Mailing Address - Fax:844-550-9971
Practice Address - Street 1:222 S 15TH ST # 1005N
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1680
Practice Address - Country:US
Practice Address - Phone:844-550-9970
Practice Address - Fax:844-550-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory