Organization
VITALITY PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIKO KOLIASTASIS (CEO)
(918) 636-3930
Entity
Organization
Contact information
Practice address
209 N OAK ST, SALLISAW, OK 74955-4639
(918) 636-3930
(918) 636-3930
Mailing address
209 N OAK ST, SALLISAW, OK 74955-4639
(918) 636-3930
(188) 422-2115
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
05/26/2017
Last updated
05/26/2017
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