Organization
VITAL MED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESIREE BROOKE HAUGH NP (OWNER/NP)
(662) 368-3858
Entity
Organization
Contact information
Practice address
103 RIDGEMONT VILLA, BOONEVILLE, MS 38829-1010
(662) 368-3858
(662) 368-3931
Mailing address
103 RIDGEMONT VILLA, BOONEVILLE, MS 38829-1010
(662) 368-3858
(662) 368-3931
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02056754
—
MS
Enumeration date
01/23/2020
Last updated
01/23/2020
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