| Vitality Healthcare | |
|
343 Elm St Ste 201 Reno NV 89503-4538 | |
| (775) 470-6651 | |
| (775) 622-0788 |
| Full Name | Vitality Healthcare |
|---|---|
| Speciality | General Practice |
| Location | 343 Elm St Ste 201, Reno, Nevada |
| Authorized Official Name and Position | Lary Richard Korn (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8642662413 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Healthcare 343 Elm St Ste 201 Reno NV 89503-4538 Ph: (775) 470-6651 | Vitality Healthcare 343 Elm St Ste 201 Reno NV 89503-4538 Ph: (775) 470-6651 |
| NPI Number | 1629689310 |
|---|---|
| Provider Enumeration Date | 08/14/2020 |
| Last Update Date | 10/06/2020 |
| Medicare PECOS PAC ID | 1658797881 |
|---|---|
| Medicare Enrollment ID | O20200818002276 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629689310 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Lary Korn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255578860 PECOS PAC ID: 2264580190 Enrollment ID: I20200814002791 |
| Provider Name | Jennifer D Andrea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386029163 PECOS PAC ID: 4981913738 Enrollment ID: I20200909003476 |
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