Provider Demographics
NPI:1164866737
Name:VITALITY WELLNESS
Entity Type:Organization
Organization Name:VITALITY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:NERAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-509-3095
Mailing Address - Street 1:5740 NW 135TH ST.
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5740 NW 135TH ST.
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142
Practice Address - Country:US
Practice Address - Phone:405-509-3095
Practice Address - Fax:405-603-3450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service