Provider Demographics
NPI:1306075460
Name:VITALITY MEDICAL INC.
Entity type:Organization
Organization Name:VITALITY MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:PACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-733-4449
Mailing Address - Street 1:7910 S 3500 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5833
Mailing Address - Country:US
Mailing Address - Phone:801-733-4449
Mailing Address - Fax:801-733-5797
Practice Address - Street 1:7910 S 3500 E
Practice Address - Street 2:SUITE C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-5833
Practice Address - Country:US
Practice Address - Phone:801-733-4449
Practice Address - Fax:801-733-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF49313332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5060570001Medicare NSC