| Vitality Health Solutions, Llc | |
|
1118 W Broadway St Muskogee OK 74401-6246 | |
| (918) 912-7040 | |
| (918) 912-7045 |
| Full Name | Vitality Health Solutions, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1118 W Broadway St, Muskogee, Oklahoma |
| Authorized Official Name and Position | Lisa S Briscoe (MANAGER) |
| Authorized Official Contact | 9188087626 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Health Solutions, Llc 1118 W Broadway St Muskogee OK 74401-6246 Ph: (918) 912-7040 | Vitality Health Solutions, Llc 1118 W Broadway St Muskogee OK 74401-6246 Ph: (918) 912-7040 |
| NPI Number | 1518641836 |
|---|---|
| Provider Enumeration Date | 06/15/2023 |
| Last Update Date | 12/02/2025 |
| Medicare PECOS PAC ID | 7618419409 |
|---|---|
| Medicare Enrollment ID | O20240607002475 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518641836 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Julia Brakefield Pino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821768086 PECOS PAC ID: 1658769468 Enrollment ID: I20211028000360 |
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