Provider Demographics
NPI:1336767516
Name:VITAL HEALTHCARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:VITAL HEALTHCARE SPECIALISTS LLC
Other - Org Name:VITAL HEALTHCARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:
Authorized Official - Last Name:AKOH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:775-335-7450
Mailing Address - Street 1:4338 W THOMAS RD # U1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-3878
Mailing Address - Country:US
Mailing Address - Phone:775-335-7450
Mailing Address - Fax:602-825-1739
Practice Address - Street 1:4338 W THOMAS RD # U1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3878
Practice Address - Country:US
Practice Address - Phone:775-335-7450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty