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Organization
VITALITY FAMILY HEALTHCARE, LLC
Active
Organization
VITALITY FAMILY HEALTHCARE, LLC
Active
Other names
Vitality Family Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB CHRISTOPHER PETERSON MD (CEO, PHYSICIAN)
(308) 865-0703
Entity
Organization
Contact information
Practice address
1028 N WEBB RD STE E, GRAND ISLAND, NE 68803-3318
(308) 865-0703
(308) 865-0703
Mailing address
521 WEST AVE, HOLDREGE, NE 68949-2226
(308) 865-0703
(308) 865-0703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
NULL
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
NULL
3336C0002X
Clinic Pharmacy
—
NULL
Other
Enumeration date
02/06/2023
Last updated
02/06/2023
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