Provider Demographics
NPI:1467991109
Name:VITALITY MEDICAL CENTERS OF FORT MILL INC
Entity Type:Organization
Organization Name:VITALITY MEDICAL CENTERS OF FORT MILL INC
Other - Org Name:VMC OF FORT MILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:DENNAE
Authorized Official - Last Name:HANDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-218-9886
Mailing Address - Street 1:PO BOX 1320
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1670 HIGHWAY 160 W STE 201
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8064
Practice Address - Country:US
Practice Address - Phone:803-560-6991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty