Provider Demographics
NPI:1629688171
Name:METTA VITA HEALTH LLC
Entity Type:Organization
Organization Name:METTA VITA HEALTH LLC
Other - Org Name:LINDSEY B. HEALTH SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:419-297-3657
Mailing Address - Street 1:1808 SECOND BAXTER XING
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708
Mailing Address - Country:US
Mailing Address - Phone:419-297-3657
Mailing Address - Fax:
Practice Address - Street 1:1808 SECOND BAXTER XING STE 208
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6492
Practice Address - Country:US
Practice Address - Phone:419-297-3657
Practice Address - Fax:833-728-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty