Provider Demographics
NPI:1427337641
Name:VITALITY MEDICAL CENTER OF HOUSTON
Entity type:Organization
Organization Name:VITALITY MEDICAL CENTER OF HOUSTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:CHATMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:832-207-4413
Mailing Address - Street 1:12310 AMANDA PINES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-7002
Mailing Address - Country:US
Mailing Address - Phone:832-328-7103
Mailing Address - Fax:
Practice Address - Street 1:457 UVALDE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3717
Practice Address - Country:US
Practice Address - Phone:832-328-7103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service