VITAL MED LLC (NPI# 1710517347) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710517347 |
| Entity Type | Organization |
| Organization Name | VITAL MED LLC |
| Practice Address |
103 Ridgemont Villa Booneville MS 38829-1010 |
| Practice Telephone | 6623683858 |
| Practice Fax Number | 6623683931 |
| Mailing Telephone | 6623683858 |
| Mailing Fax Number | 6623683931 |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2020-01-23 |
| Authorized Official Name | DESIREE BROOKE HAUGH (OWNER/NP) |
| Authorized Official Telephone | 6623683858 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 02056754 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790163095 | Vital Med LLC | Pharmacy | 6942 Main St, Flushing, NY 11367-1723 | 2015-05-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | VITAL MED LLC | 283 Commack Road, Commack, Ny 11725 |
| Street Address |
103 RIDGEMONT VILLA |
| City | BOONEVILLE |
| State | MS |
| Zip Code | 38829-1010 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275943086 | Desiree Brooke Haugh | Nurse Practitioner | 103 Ridgemont Villa, Booneville, MS 38829-1010 | 2014-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962029249 | Ortho Express Holding Company, LLC | Clinic/Center | 608 W Church St, Booneville, MS 38829 | 2020-07-02 |
| 1073142600 | Chelsea Cara Mcmillin | Registered Nurse | 2014 C East Chambers Drive, Booneville, MS 38829 | 2020-04-06 |
| 1396210274 | Hooper Transportation LLC | Private Vehicle | 105 Jacinto Heights, No 2, Booneville, MS 38829 | 2018-10-08 |
| 1699251314 | John L Hooper | Driver | 105 Jacinto Heights No 2, Booneville, MS 38829 | 2018-07-16 |
| 1750744389 | Jeni Ramey | Social Worker | 214 Dogwood Estates, Booneville, MS 38829 | 2016-03-31 |
| 1770944977 | Judy Dillard | Peer Specialist | 2100 Chambers Drive, Booneville, MS 38829 | 2016-03-15 |
| 1508253295 | Mary Grace Hancock | Internal Medicine | 202 N 1st St Ste B, Booneville, MS 38829 | 2015-04-20 |
| 1508042722 | Mary Dean Stone | Registered Nurse | 2100 East Chamberss, Booneville, MS 38829 | 2008-01-17 |
| 1144406430 | Amy Cole | Registered Nurse | 2100 East Chambers, Booneville, MS 38829 | 2008-01-16 |
| 1972715118 | Rita D. Jones | Nurse Practitioner | 1907 South Lake Street, Booneville, MS 38829 | 2007-05-03 |
| Find all providers in zip 38829 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
| 1063911485 | Faith Family Clinic of Booneville | Clinic/Center | 2209 N 2nd St, Booneville, MS 38829-7734 | 2018-02-12 |
| 1992258255 | North Mississippi Medical Center | Clinic/Center | 1301 N 2nd St, Booneville, MS 38829-1028 | 2016-08-03 |
| 1831288281 | Faith Family Clinic, LLC | Clinic/Center | 2209 N 2nd St, Booneville, MS 38829-7734 | 2006-10-12 |
| 1902997059 | Family Med 101, Inc | Clinic/Center | 101 Mimosa St, Booneville, MS 38829-2911 | 2006-09-27 |
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| 1316421373 | Children's International, LLC | Clinic/Center | 2003 Wildwood Rd, Picayune, MS 39466-2178 | 2018-09-17 |
| 1124505912 | Thaxton Family Medical Clinic LLC | Clinic/Center | 11145 Highway 6 W, Thaxton, MS 38871-9024 | 2018-07-24 |
| 1316439615 | Quad/med, LLC | Clinic/Center | 1000 Jere St. Pe' Hwy, C/o Ingalls Main Substation, 1st Floor, Pascagoula, MS 39567 | 2018-06-01 |
| 1194215681 | Brooks Medical Clinic | Clinic/Center | 2113 South Tate Street, Corinth, MS 38834 | 2018-05-10 |
| Find all providers with the same taxonomy | ||||
| City | BOONEVILLE |
| Zip Code | 38829 |
Please comment or provide details below to improve the information on VITAL MED LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.