Provider Demographics
NPI:1174706881
Name:FLU SHOTS OF TEXAS, LTD
Entity type:Organization
Organization Name:FLU SHOTS OF TEXAS, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:VITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-759-7468
Mailing Address - Street 1:PO BOX 201529
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-1529
Mailing Address - Country:US
Mailing Address - Phone:972-759-7468
Mailing Address - Fax:972-759-1518
Practice Address - Street 1:2300 VALLEY VIEW LN STE 100
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-5743
Practice Address - Country:US
Practice Address - Phone:972-759-7468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPH0544Medicare PIN