VIVACIOUS GROUP INC. NPI 1275702888

NPI Information

NPI: 1275702888
Provider Name: VIVACIOUS GROUP INC.
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 14D1107160

Address:
8S165 S VINE ST
BURR RIDGE, IL
ZIP 60527
Phone: (630) 835-7613
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VIVACIOUS GROUP INC. is a primary care clinic center in Burr Ridge, IL. VIVACIOUS GROUP INC. NPI is 1275702888. The provider is registered as an organization entity type.

The provider's business location address is:

8S165 S VINE ST
BURR RIDGE, IL
ZIP 60527-541
Phone: (630) 835-7613

The provider's authorized official is Anto Maliakkal .
The authorized official title is President and has the following contact phone number (630) 835-7613.

The CLIA number assigned to this NPI record is 14D1107160 - mobile laboratory with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/27/2008 and was last updated on 5/31/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care		ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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