Healthcare Provider Details

I. General information

NPI: 1659705424
Provider Name (Legal Business Name): VIBRA PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 UNION ST
JOHNSTOWN CO
80534-2800
US

IV. Provider business mailing address

5 E RIVER PARK PL E STE 460
FRESNO CA
93720-1405
US

V. Phone/Fax

Practice location:
  • Phone: 970-278-9340
  • Fax:
Mailing address:
  • Phone: 559-892-2500
  • Fax: 559-892-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. CLINT T. FEGAN
Title or Position: SECRETARY
Credential:
Phone: 717-591-5700