Provider Demographics
NPI:1063596534
Name:VITAL MEDICAL SERVICES, PA
Entity type:Organization
Organization Name:VITAL MEDICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:RUEY-MING
Authorized Official - Last Name:YEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-328-2999
Mailing Address - Street 1:2638 LAKEFOREST CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3881
Mailing Address - Country:US
Mailing Address - Phone:214-328-2999
Mailing Address - Fax:
Practice Address - Street 1:1900 OATES DR STE 138
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6802
Practice Address - Country:US
Practice Address - Phone:972-270-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1958261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG31215Medicare UPIN