| Vital Health Primary Care Llc | |
|
930 Henrietta Ave Ste C Huntingdon Valley PA 19006-8523 | |
| (215) 663-9380 | |
| (215) 663-9383 |
| Full Name | Vital Health Primary Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 930 Henrietta Ave Ste C, Huntingdon Valley, Pennsylvania |
| Authorized Official Name and Position | Jessly Alex (AUTHORIZED SIGNATORY) |
| Authorized Official Contact | 2157382072 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vital Health Primary Care Llc 293 Pheasant Dr Huntingdon Valley PA 19006-3036 Ph: () - | Vital Health Primary Care Llc 930 Henrietta Ave Ste C Huntingdon Valley PA 19006-8523 Ph: (215) 663-9380 |
| NPI Number | 1992315659 |
|---|---|
| Provider Enumeration Date | 08/06/2020 |
| Last Update Date | 09/09/2021 |
| Medicare PECOS PAC ID | 6709205743 |
|---|---|
| Medicare Enrollment ID | O20200924002736 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992315659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jessly Alex |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235598210 PECOS PAC ID: 2961785829 Enrollment ID: I20170220002064 |
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