| Vitality Medical And Wellness Consulting Llc | |
|
3009 N Ballas Rd Ste 215b Saint Louis MO 63131-2323 | |
| (314) 695-8525 | |
| Not Available |
| Full Name | Vitality Medical And Wellness Consulting Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3009 N Ballas Rd Ste 215b, Saint Louis, Missouri |
| Authorized Official Name and Position | Amy Loden (CEO) |
| Authorized Official Contact | 3143359151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Medical And Wellness Consulting Llc 639 Amberwood Ln Ballwin MO 63021-5888 Ph: (314) 335-9151 | Vitality Medical And Wellness Consulting Llc 3009 N Ballas Rd Ste 215b Saint Louis MO 63131-2323 Ph: (314) 695-8525 |
| NPI Number | 1992390421 |
|---|---|
| Provider Enumeration Date | 03/05/2021 |
| Last Update Date | 05/03/2021 |
| Medicare PECOS PAC ID | 4880002286 |
|---|---|
| Medicare Enrollment ID | O20210423002195 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992390421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Amy Loden |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417189564 PECOS PAC ID: 9032353339 Enrollment ID: I20130925000923 |
| Provider Name | Anna Whaley Burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306409768 PECOS PAC ID: 2062821945 Enrollment ID: I20210505001019 |
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