Provider Demographics
NPI:1356686562
Name:VITALUS AIRWAY 562, LLC
Entity type:Organization
Organization Name:VITALUS AIRWAY 562, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:PEAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-782-1033
Mailing Address - Street 1:2727 ALLEN PARKWAY, SUITE 1915
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-2115
Mailing Address - Country:US
Mailing Address - Phone:281-968-2300
Mailing Address - Fax:281-968-2301
Practice Address - Street 1:10019 S. MAIN ST.
Practice Address - Street 2:SUITE A9-D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025
Practice Address - Country:US
Practice Address - Phone:281-968-2300
Practice Address - Fax:281-968-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies