Provider Demographics
NPI:1942900527
Name:VITAL PHYSICIANS PLLC
Entity Type:Organization
Organization Name:VITAL PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-647-2009
Mailing Address - Street 1:PO BOX 941912
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-1912
Mailing Address - Country:US
Mailing Address - Phone:407-647-2009
Mailing Address - Fax:407-660-2009
Practice Address - Street 1:623 MAITLAND AVE STE 1101
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6823
Practice Address - Country:US
Practice Address - Phone:407-647-2009
Practice Address - Fax:407-660-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty