| Vital Med LLC | |
|
103 Ridgemont Villa Booneville MS 38829-1010 | |
| (662) 368-3858 | |
| (662) 368-3931 |
| Full Name | Vital Med LLC |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 103 Ridgemont Villa, Booneville, Mississippi |
| Authorized Official Name and Position | Desiree Brooke Haugh (OWNER/NP) |
| Authorized Official Contact | 6623683858 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vital Med LLC 103 Ridgemont Villa Booneville MS 38829-1010 Ph: (662) 368-3858 | Vital Med LLC 103 Ridgemont Villa Booneville MS 38829-1010 Ph: (662) 368-3858 |
| NPI Number | 1710517347 |
|---|---|
| Provider Enumeration Date | 01/23/2020 |
| Last Update Date | 01/23/2020 |
| Certification Date | 01/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710517347 | NPI | - | NPPES |
| 02056754 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
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