Vitaglide, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

VITAGLIDE, LLC

Doing business as

VitaGlide, LLC

Practice address

419 Hawk St
Rockledge, FL 32955-3291

Phone

(305) 514-0514

NPI assigned

Jul 17, 2022

Last updated

Jul 17, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marcelyn Sue Ullom

Title

Chief Executive Officer

Phone

(305) 514-0514

Specialties & licenses 1

Addresses

Other names 1

• VitaGlide, LLC Doing business as

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658016000000",
    "number": "1023743879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2445 RIVERVIEW DR NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329052515",
            "telephone_number": "305-586-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 HAWK ST",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329553291",
            "telephone_number": "305-514-0514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAGLIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-17",
        "last_updated": "2022-07-17",
        "certification_date": "2022-07-17",
        "status": "A",
        "authorized_official_last_name": "ULLOM",
        "authorized_official_first_name": "MARCELYN",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "305-514-0514"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.vitaglide.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "website",
            "address_1": "2445 Riverview Dr NE",
            "city": "Palm Bay",
            "state": "FL",
            "country_code": "US",
            "postal_code": "329052515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "VitaGlide, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Rockledge, FL
• Providers in Rockledge, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.