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General NPI Number Information
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NPI Number | 1518641836
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Entity Type | Organization
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Legal Business Name | VITALITY HEALTH SOLUTIONS, LLC
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1118 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-6246
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Country | US
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Telephone | 918-912-7040
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Fax | 918-912-7045
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Provider Business Mailing Address
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Address Line | 1118 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-6246
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Country | US
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Telephone | 918-912-7040
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Fax | 918-912-7045
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Authorized Official
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Title or Position | MANAGER
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Name | LISA S BRISCOE
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Credential |
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Telephone | 918-808-7626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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