NPIMap

Organization Active NPI

Lifevantage House Calls PLLC

  • General Practice Physician
  • Fort Worth, TX
National Provider Identifier
1679963771
Registry record updated Jan 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
LIFEVANTAGE HOUSE CALLS PLLC
Practice address
9101 Nightingale Dr
Fort Worth, TX 76123-2713
Phone
(817) 739-4007
NPI assigned
Jan 27, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2015

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

Authorized official

Name
Raymond Andrada
Title
Owner
Phone
(817) 739-4007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

9101 Nightingale Dr
Fort Worth, TX 76123-2713

Mailing address

9101 Nightingale Dr
Fort Worth, TX 76123-2713
Phone (817) 739-4007

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422316800000",
    "number": "1679963771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9101 NIGHTINGALE DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761232713",
            "telephone_number": "817-739-4007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9101 NIGHTINGALE DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761232713",
            "telephone_number": "817-739-4007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEVANTAGE HOUSE CALLS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-27",
        "last_updated": "2015-01-27",
        "status": "A",
        "authorized_official_last_name": "ANDRADA",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-739-4007"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; 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.