Organization
VITALITY FAMILY HEALTHCARE, LLC
Active
Other names
Vitality Family Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB CHRISTOPHER PETERSON MD (CEO, PHYSICIAN)
(308) 865-0703
Entity
Organization
Contact information
Practice address
1028 N WEBB RD STE E, GRAND ISLAND, NE 68803-3318
(308) 865-0703
(308) 865-0703
Mailing address
521 WEST AVE, HOLDREGE, NE 68949-2226
(308) 865-0703
(308) 865-0703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Enumeration date
02/06/2023
Last updated
02/06/2023
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