| Internal Medicine And Vitality, Pllc | |
|
6505 Constitution Blvd Ste C Portage MI 49024-1605 | |
| (269) 762-4120 | |
| (269) 254-8413 |
| Full Name | Internal Medicine And Vitality, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6505 Constitution Blvd Ste C, Portage, Michigan |
| Authorized Official Name and Position | Amanda R Henry (OWNER) |
| Authorized Official Contact | 2697624120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine And Vitality, Pllc 6505 Constitution Blvd Ste C Portage MI 49024-1605 Ph: (269) 762-4120 | Internal Medicine And Vitality, Pllc 6505 Constitution Blvd Ste C Portage MI 49024-1605 Ph: (269) 762-4120 |
| NPI Number | 1073357737 |
|---|---|
| Provider Enumeration Date | 06/19/2024 |
| Last Update Date | 01/06/2025 |
| Medicare PECOS PAC ID | 0042757999 |
|---|---|
| Medicare Enrollment ID | O20240808004547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073357737 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Amanda Rose Henry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548464035 PECOS PAC ID: 4880723493 Enrollment ID: I20100519000938 |
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