Organization
VITALITY MEDICAL SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD PAVELOCK MD (OWNER)
(704) 880-8665
Entity
Organization
Contact information
Practice address
2632 FINES CREEK DR, STATESVILLE, NC 28625-4441
(704) 728-9509
Mailing address
2632 FINES CREEK DR, STATESVILLE, NC 28625-4441
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
39460
NC
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196006
NC MEDICAL BOARD CERTIFICATE
—
05
—
8966248
—
NC
Enumeration date
10/17/2015
Last updated
10/17/2015
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