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General NPI Number Information
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NPI Number | 1952938045
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Entity Type | Organization
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Legal Business Name | VITALITY MEDICAL CENTER
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 3534 JOHN F KENNEDY PKWY STE B
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City | FORT COLLINS
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State | CO
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Zip | 80525-2668
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Country | US
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Telephone | 970-631-4173
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Fax |
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Provider Business Mailing Address
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Address Line | 3534 JOHN F KENNEDY PKWY STE B
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City | FORT COLLINS
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State | CO
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Zip | 80525-2668
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Country | US
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Telephone | 970-631-4173
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | TARRYN FARRELL
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Credential |
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Telephone | 970-631-4173
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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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