| Vibrant Vitality Medical Wellness Center Pc | |
|
13175 Haskell Pl Carmel IN 46074-8332 | |
| (317) 850-6496 | |
| Not Available |
| Full Name | Vibrant Vitality Medical Wellness Center Pc |
|---|---|
| Speciality | General Practice |
| Location | 13175 Haskell Pl, Carmel, Indiana |
| Authorized Official Name and Position | Ted T Lai (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3178506496 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vibrant Vitality Medical Wellness Center Pc 13175 Haskell Pl Carmel IN 46074-8332 Ph: (317) 850-6496 | Vibrant Vitality Medical Wellness Center Pc 13175 Haskell Pl Carmel IN 46074-8332 Ph: (317) 850-6496 |
| NPI Number | 1265891279 |
|---|---|
| Provider Enumeration Date | 02/18/2016 |
| Last Update Date | 02/18/2016 |
| Medicare PECOS PAC ID | 6002106093 |
|---|---|
| Medicare Enrollment ID | O20160603000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265891279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 50005071A (Indiana) | Primary |
| Provider Name | Ted T Lai |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982691671 PECOS PAC ID: 4183684855 Enrollment ID: I20041016000228 |
| Provider Name | Annamarie Salyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386041853 PECOS PAC ID: 2860710183 Enrollment ID: I20150417000797 |
| Provider Name | Nicholle M Hise |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023472735 PECOS PAC ID: 5193024818 Enrollment ID: I20160502002230 |
| Provider Name | Melissa Leann Humburg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841745577 PECOS PAC ID: 3274813522 Enrollment ID: I20161205000113 |
| Provider Name | Sarah M Jayroe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083169932 PECOS PAC ID: 6507146503 Enrollment ID: I20161209000071 |
| Provider Name | Scott F Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912449273 PECOS PAC ID: 1759661630 Enrollment ID: I20161212000691 |
| Provider Name | Sei Young V Kwak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689126674 PECOS PAC ID: 4587949946 Enrollment ID: I20170327001574 |
| Provider Name | Rebecca K Barger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275072811 PECOS PAC ID: 6406133958 Enrollment ID: I20170510001270 |
| Provider Name | Erin R Brophy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851837702 PECOS PAC ID: 8729355144 Enrollment ID: I20170606000934 |
| Provider Name | Sarah B Lawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114452604 PECOS PAC ID: 3678843174 Enrollment ID: I20170717000844 |
| Provider Name | Ricci Contessa Belisario |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720437056 PECOS PAC ID: 4385919497 Enrollment ID: I20171120002723 |
| Provider Name | Sarah Anne Keehn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891277802 PECOS PAC ID: 4587900196 Enrollment ID: I20190117002661 |
| Provider Name | Stephanie N Preston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447882840 PECOS PAC ID: 1052741295 Enrollment ID: I20200430001839 |
| Provider Name | Amber Lynn Dever |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700412855 PECOS PAC ID: 4284048083 Enrollment ID: I20210205000333 |
| Provider Name | Carmin M Stevenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306593124 PECOS PAC ID: 6305226085 Enrollment ID: I20220712002521 |
| Provider Name | Grace Ochs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558079897 PECOS PAC ID: 8729458955 Enrollment ID: I20230105000833 |
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