Provider Demographics
NPI:1639539455
Name:VITALITY MEDICAL LLC
Entity Type:Organization
Organization Name:VITALITY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-717-1073
Mailing Address - Street 1:12228 JOURNEYS END TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2422
Mailing Address - Country:US
Mailing Address - Phone:704-895-5448
Mailing Address - Fax:704-896-1761
Practice Address - Street 1:16415 NORTHCROSS DR
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5001
Practice Address - Country:US
Practice Address - Phone:704-895-5448
Practice Address - Fax:704-896-1761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-011212083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Single Specialty