NPIMap

Organization Active NPI

Renewed Vitality LLC

  • Family Medicine Physician
  • Dallas, TX
National Provider Identifier
1578849634
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J7209 Issued in TX
Legal business name
RENEWED VITALITY LLC
Practice address
9535 Forest Lane
Suite 100
Dallas, TX 75243
Phone
(214) 389-1234
Fax
(214) 389-1230
NPI assigned
Nov 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Authorized official

Name
Mr. William S Rickett, PRESIDENT
Title
President
Phone
(682) 554-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X J7209 TX Primary

Addresses

Primary practice location

9535 Forest Lane
Suite 100
Dallas, TX 75243

Mailing address

9535 Forest Lane
Suite 100
Dallas, TX 75243
Phone (214) 389-1234

National Provider Directory

National Provider Directory

Locations

9535 Forest Ln
Ste 100
Dallas, TX 75243
Phone (214) 384-1234

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1320192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320192000000",
    "number": "1578849634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9535 FOREST LANE",
            "address_2": "SUITE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75243",
            "telephone_number": "214-389-1234",
            "fax_number": "214-389-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9535 FOREST LANE",
            "address_2": "SUITE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75243",
            "telephone_number": "214-389-1234",
            "fax_number": "214-389-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEWED VITALITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-02",
        "last_updated": "2011-11-02",
        "status": "A",
        "authorized_official_last_name": "RICKETT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "682-554-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PRESIDENT"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J7209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; 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.