| Vital Path Health Services | |
|
1621 Central Ave Cheyenne WY 82001-4531 | |
| (818) 517-8743 | |
| Not Available |
| Full Name | Vital Path Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 1621 Central Ave, Cheyenne, Wyoming |
| Authorized Official Name and Position | Peter Simonian (CEO) |
| Authorized Official Contact | 8185178743 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vital Path Health Services 1621 Central Ave Cheyenne WY 82001-4531 | Vital Path Health Services 1621 Central Ave Cheyenne WY 82001-4531 Ph: (818) 517-8743 |
| NPI Number | 1134093180 |
|---|---|
| Provider Enumeration Date | 10/02/2025 |
| Last Update Date | 10/02/2025 |
| Certification Date | 10/02/2025 |
| Medicare PECOS PAC ID | 9638657869 |
|---|---|
| Medicare Enrollment ID | O20260129002942 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134093180 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Samantha Camille De La Cruz Kasingsing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477349363 PECOS PAC ID: 7517474695 Enrollment ID: I20250724003938 |
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