Provider Demographics
NPI:1457129439
Name:VITAL FLOW MEDICINE
Entity Type:Organization
Organization Name:VITAL FLOW MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-544-4794
Mailing Address - Street 1:1001 SW HIGGINS AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1340
Mailing Address - Country:US
Mailing Address - Phone:406-540-0081
Mailing Address - Fax:406-284-0678
Practice Address - Street 1:1001 SW HIGGINS AVE STE 104
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1340
Practice Address - Country:US
Practice Address - Phone:406-540-0081
Practice Address - Fax:406-284-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty