Organization
VITALITY ME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH L KEEFER (BILLING)
(920) 886-0818
Entity
Organization
Contact information
Practice address
300 N COMMERCIAL ST, SUITE 2, NEENAH, WI 54956-2619
(920) 886-0818
Mailing address
300 N COMMERCIAL ST, NEENAH, WI 54956-2619
(920) 886-0818
(920) 886-0573
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
421430202
WI
261QM2500X
Medical Specialty Clinic/Center
Primary
42143020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42143-020
LICENSE NUMBER
WI
Enumeration date
02/18/2013
Last updated
02/18/2013
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