Provider Demographics
NPI:1851097406
Name:VITALITY FAMILY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:VITALITY FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-865-0703
Mailing Address - Street 1:521 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-2226
Mailing Address - Country:US
Mailing Address - Phone:308-865-0703
Mailing Address - Fax:308-865-0703
Practice Address - Street 1:1028 N WEBB RD STE E
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3318
Practice Address - Country:US
Practice Address - Phone:308-865-0703
Practice Address - Fax:308-865-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No3336C0002XSuppliersPharmacyClinic PharmacyGroup - Multi-Specialty