Provider Demographics
NPI:1013334887
Name:VITAL HEALTH, LLC
Entity Type:Organization
Organization Name:VITAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELKER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-726-1155
Mailing Address - Street 1:1200 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2114
Mailing Address - Country:US
Mailing Address - Phone:541-762-1155
Mailing Address - Fax:541-726-1154
Practice Address - Street 1:1200 EXECUTIVE PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2114
Practice Address - Country:US
Practice Address - Phone:541-762-1155
Practice Address - Fax:541-726-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty