Provider Demographics
NPI:1306489323
Name:VITALANT
Entity type:Organization
Organization Name:VITALANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL & RISK OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BHAVI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-675-5653
Mailing Address - Street 1:875 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3508
Mailing Address - Country:US
Mailing Address - Phone:412-209-7456
Mailing Address - Fax:412-209-7095
Practice Address - Street 1:201 N CRAIG ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1567
Practice Address - Country:US
Practice Address - Phone:412-209-7456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory