Provider Demographics
NPI:1235024290
Name:VITAL CLINICAL LABORATORY INC
Entity type:Organization
Organization Name:VITAL CLINICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GHEVOND
Authorized Official - Middle Name:
Authorized Official - Last Name:KECHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-906-1005
Mailing Address - Street 1:16910 DALLAS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1927
Mailing Address - Country:US
Mailing Address - Phone:469-906-1005
Mailing Address - Fax:469-906-1006
Practice Address - Street 1:16910 DALLAS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1927
Practice Address - Country:US
Practice Address - Phone:469-906-1005
Practice Address - Fax:469-906-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory