MEDICARE: VITALITY HEALTH SOLUTIONS, 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	261Q00000X	Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1518641836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY HEALTH SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	1118 W BROADWAY ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-6246
Country	:	US
Telephone Number	:	918-912-7040
Fax Number	:	918-912-7045

Provider Business Practice Location Address
First Line	:	1118 W BROADWAY ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-6246
Country	:	US
Telephone Number	:	918-912-7040
Fax Number	:	918-912-7045

Authorized Official
Title or Position	:	MANAGER
Name	:	LISA S BRISCOE
Credential	:
Telephone Number	:	918-808-7626

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	12/11/2025

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