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General NPI Number Information
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NPI Number | 1902613813
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Entity Type | Organization
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Legal Business Name | VITALITY FUNCTIONAL FAMILY MEDICINE
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 2514 E 15TH ST STE A
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City | TULSA
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State | OK
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Zip | 74104-4655
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Country | US
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Telephone | 918-237-9889
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Fax |
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Provider Business Mailing Address
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Address Line | 2514 E 15TH ST STE A
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City | TULSA
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State | OK
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Zip | 74104-4655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | CHRIS SMITH
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Credential |
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Telephone | 918-237-9889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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