MEDICARE: VITALITY PAIN MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1023841160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY PAIN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	2700 OLD ROSEBUD RD STE 330
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 CAVE MILL RD
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-4682
Country	:	US
Telephone Number	:	859-340-1807
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID BOSOMWORTH
Credential	:
Telephone Number	:	502-290-7246

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	01/16/2026

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