Vitality Medical Llc | |
110 Holt Dr Madison IN 47250-3873 | |
(812) 265-6141 | |
Not Available |
Full Name | Vitality Medical Llc |
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Speciality | General Practice |
Location | 110 Holt Dr, Madison, Indiana |
Authorized Official Name and Position | Joshua Bronson (OWNER) |
Authorized Official Contact | 6162040074 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Vitality Medical Llc 110 Holt Dr Madison IN 47250-3873 Ph: (812) 265-6141 | Vitality Medical Llc 110 Holt Dr Madison IN 47250-3873 Ph: (812) 265-6141 |
NPI Number | 1447984265 |
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Provider Enumeration Date | 07/16/2022 |
Last Update Date | 07/16/2022 |
Medicare PECOS PAC ID | 6103294921 |
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Medicare Enrollment ID | O20221128002500 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447984265 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Joshua Lee Bronson |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1932617370 PECOS PAC ID: 4880954361 Enrollment ID: I20180131002400 |
Provider Name | Patricia Brown-grayson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205348489 PECOS PAC ID: 2961836689 Enrollment ID: I20220426002978 |
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