Provider Demographics
NPI:1356175756
Name:VITA MEDICORP LLC
Entity type:Organization
Organization Name:VITA MEDICORP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRIKANTH REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLAKATALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-709-1123
Mailing Address - Street 1:2020 W 3RD ST STE 302
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4464
Mailing Address - Country:US
Mailing Address - Phone:214-709-1123
Mailing Address - Fax:
Practice Address - Street 1:2020 W 3RD ST STE 302
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4464
Practice Address - Country:US
Practice Address - Phone:214-709-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies