MEDICARE: VITALITY PAIN MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	363AM0700X	Medical Physician Assistant
3	208VP0000X	Pain Medicine Physician
4	207LP2900X	Pain Medicine (Anesthesiology) Physician
5	367500000X	Certified Registered Nurse Anesthetist
6	363L00000X	Nurse Practitioner
7	208100000X	Physical Medicine & Rehabilitation Physician
8	367H00000X	Anesthesiologist Assistant
9	332B00000X	Durable Medical Equipment & Medical Supplies
10	363A00000X	Physician Assistant
11	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1780463653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY PAIN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	2700 OLD ROSEBUD RD STE 330
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8630
Country	:	US
Telephone Number	:	859-340-1807
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 OLD ROSEBUD RD STE 330
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8630
Country	:	US
Telephone Number	:	502-352-2530
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID BOSOMWORTH II
Credential	:
Telephone Number	:	859-340-1807

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	01/16/2026

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Directions to “VITALITY PAIN MANAGEMENT LLC ” Practice Location

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