Organization
VITALITY MEDICAL CENTERS, INC.
Active
Other names
Vitality Spine Center, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
JASON B FARMER (OWNER)
(803) 244-9212
Entity
Organization
Contact information
Practice address
101 MEDICAL CIR STE A, WEST COLUMBIA, SC 29169-3650
(803) 244-9212
(803) 708-0865
Mailing address
PO BOX 7227, WEST COLUMBIA, SC 29171-7227
(803) 244-9212
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7059550001
MEDICARE DME PTAN
SC
05
—
GP6730
—
SC
Enumeration date
06/15/2011
Last updated
08/30/2024
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