| Vytalize Health | |
|
1071 E Franklin St Carthage MS 39051-3601 | |
| (601) 267-4562 | |
| Not Available |
| Full Name | Vytalize Health |
|---|---|
| Speciality | Family Medicine |
| Location | 1071 E Franklin St, Carthage, Mississippi |
| Authorized Official Name and Position | Faris Ghawi (CEO / CO-FOUNDER) |
| Authorized Official Contact | 2022866666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vytalize Health 2 Hudson Pl Fl 6 Hoboken NJ 07030-5594 Ph: (201) 205-2628 | Vytalize Health 1071 E Franklin St Carthage MS 39051-3601 Ph: (601) 267-4562 |
| NPI Number | 1568083533 |
|---|---|
| Provider Enumeration Date | 05/01/2020 |
| Last Update Date | 05/18/2021 |
| Medicare PECOS PAC ID | 9032532395 |
|---|---|
| Medicare Enrollment ID | O20200706002467 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568083533 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | David Lawrence Moody |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346359197 PECOS PAC ID: 7113838715 Enrollment ID: I20040928000103 |
| Provider Name | Manuel Lim Ong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932158664 PECOS PAC ID: 1759350739 Enrollment ID: I20040928000411 |
| Provider Name | Lucius M Lampton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689781007 PECOS PAC ID: 0547221798 Enrollment ID: I20041021000705 |
| Provider Name | Carla Mitchell Armstrong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346238359 PECOS PAC ID: 9638118433 Enrollment ID: I20110126000762 |
| Provider Name | William L Striegel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205947843 PECOS PAC ID: 4486836566 Enrollment ID: I20110310000509 |
| Provider Name | Degail Jamar Hadley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720216955 PECOS PAC ID: 4284882408 Enrollment ID: I20130411000006 |
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