Provider Demographics
NPI:1437132024
Name:VITAL LINE CORPORATION
Entity type:Organization
Organization Name:VITAL LINE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-213-5070
Mailing Address - Street 1:221 E. WISCONSIN RD
Mailing Address - Street 2:P.O. BOX 3666
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540
Mailing Address - Country:US
Mailing Address - Phone:956-383-5527
Mailing Address - Fax:956-383-4592
Practice Address - Street 1:221 E. WISCONSIN RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78540
Practice Address - Country:US
Practice Address - Phone:956-383-5527
Practice Address - Fax:956-383-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000694201Medicaid
TXAMB025Medicare ID - Type Unspecified