Provider Demographics
NPI:1104693969
Name:VITALITY MEDICAL CLINIC, PLLC
Entity type:Organization
Organization Name:VITALITY MEDICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MOHSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-344-1538
Mailing Address - Street 1:2219 SAWDUST RD STE 302
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2576
Mailing Address - Country:US
Mailing Address - Phone:832-245-9892
Mailing Address - Fax:321-323-3740
Practice Address - Street 1:2219 SAWDUST RD STE 302
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2576
Practice Address - Country:US
Practice Address - Phone:832-245-9892
Practice Address - Fax:321-323-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty