# VITALITY FAMILY HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vitality Family Healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851097406
- **Authorized official:** DR. JACOB CHRISTOPHER PETERSON MD (CEO, PHYSICIAN)
- **Authorized official phone:** (308) 865-0703

## Contact information

- **Practice address:** 1028 N WEBB RD STE E, GRAND ISLAND, NE 68803-3318
- **Practice address phone:** (308) 865-0703
- **Practice address fax:** (308) 865-0703
- **Mailing address:** 521 WEST AVE, HOLDREGE, NE 68949-2226
- **Mailing address phone:** (308) 865-0703
- **Mailing address fax:** (308) 865-0703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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