Healthcare Provider Details

I. General information

NPI: 1851756720
Provider Name (Legal Business Name): VITALITY MEDICAL CENTERS OF NORTH AUGUSTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W MARTINTOWN RD STE 200
NORTH AUGUSTA SC
29841-3106
US

IV. Provider business mailing address

PO BOX 7227
WEST COLUMBIA SC
29171-7227
US

V. Phone/Fax

Practice location:
  • Phone: 803-265-2015
  • Fax:
Mailing address:
  • Phone: 803-218-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JASON B FARMER
Title or Position: OWNER
Credential:
Phone: 803-244-9212