Provider Demographics
NPI:1801155395
Name:HEALTH & VITALITY LLC
Entity type:Organization
Organization Name:HEALTH & VITALITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-378-4643
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-5000
Mailing Address - Country:US
Mailing Address - Phone:877-378-4643
Mailing Address - Fax:615-547-9845
Practice Address - Street 1:162 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4919
Practice Address - Country:US
Practice Address - Phone:316-440-3639
Practice Address - Fax:316-440-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6626691208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty