| Vitalsmd Llc | |
|
1282 Union Ave Memphis TN 38104-3414 | |
| (662) 822-7454 | |
| Not Available |
| Full Name | Vitalsmd Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1282 Union Ave, Memphis, Tennessee |
| Authorized Official Name and Position | Lakeisha Marie Conley (SOLE MEMBER) |
| Authorized Official Contact | 6628227454 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitalsmd Llc 6515 Goodman Rd Ste 4-326 Olive Branch MS 38654-7333 Ph: (662) 822-7454 | Vitalsmd Llc 1282 Union Ave Memphis TN 38104-3414 Ph: (662) 822-7454 |
| NPI Number | 1154932754 |
|---|---|
| Provider Enumeration Date | 08/17/2020 |
| Last Update Date | 08/17/2020 |
| Medicare PECOS PAC ID | 1951729615 |
|---|---|
| Medicare Enrollment ID | O20200911000849 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154932754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Lakeisha Marie Conley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720277056 PECOS PAC ID: 2961535224 Enrollment ID: I20200911001082 |
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