Healthcare Provider Details

I. General information

NPI: 1356121461
Provider Name (Legal Business Name): VITALITY PLUS INFUSION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MEDICAL PLZ
MOUNTAIN HOME AR
72653-2962
US

IV. Provider business mailing address

19 MEDICAL PLZ STE 30
MOUNTAIN HOME AR
72653-2962
US

V. Phone/Fax

Practice location:
  • Phone: 870-232-0885
  • Fax:
Mailing address:
  • Phone: 870-232-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA VETTER
Title or Position: INFUSION CENTER DIRECTOR
Credential:
Phone: 870-232-0885