Provider Demographics
NPI:1174025746
Name:FAMILY CENTER VITALEHEALTH PLLC
Entity type:Organization
Organization Name:FAMILY CENTER VITALEHEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-410-0042
Mailing Address - Street 1:1020 FLOWER MOUND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3440
Mailing Address - Country:US
Mailing Address - Phone:972-410-0024
Mailing Address - Fax:972-410-0044
Practice Address - Street 1:1020 FLOWER MOUND RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3440
Practice Address - Country:US
Practice Address - Phone:972-410-0042
Practice Address - Fax:972-410-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty