Provider Demographics
NPI:1457139016
Name:VITAL HEALTH AND WELLNESS
Entity type:Organization
Organization Name:VITAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-264-3434
Mailing Address - Street 1:VITAL HEALTH AND WELLNESS
Mailing Address - Street 2:2100 CHESTNUT STREET
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-264-3434
Mailing Address - Fax:334-834-9071
Practice Address - Street 1:VITAL HEALTH AND WELLNESS
Practice Address - Street 2:2100 CHESTNUT STREET
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-264-3434
Practice Address - Fax:334-834-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty