Healthcare Provider Details

I. General information

NPI: 1306081955
Provider Name (Legal Business Name): VIGORWORKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 SAGE LN
PHILADELPHIA PA
19128-4556
US

IV. Provider business mailing address

PO BOX 25817
PHILADELPHIA PA
19128-5817
US

V. Phone/Fax

Practice location:
  • Phone: 215-545-2000
  • Fax:
Mailing address:
  • Phone: 215-545-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003988
License Number StatePA

VIII. Authorized Official

Name: MR. SAMUEL Y. BOTTS
Title or Position: MANAGING PARTNER
Credential:
Phone: 215-545-2000