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General NPI Number Information
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NPI Number | 1770954703
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Entity Type | Organization
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Legal Business Name | VITALITY HEALTHCARE PC
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 5717 OAKLAND DR STE A
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City | PORTAGE
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State | MI
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Zip | 49024-1116
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Country | US
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Telephone | 269-323-4473
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Fax | 269-324-0755
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Provider Business Mailing Address
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Address Line | 5717 OAKLAND DR STE A
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City | PORTAGE
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State | MI
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Zip | 49024-1116
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Country | US
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Telephone | 269-323-4473
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Fax | 269-324-0755
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES T JOSEPH
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Credential | MD
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Telephone | 269-323-4473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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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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