27D2185022 CLIA NUMBER - VITALITY MEDICAL & WELLNESS CENTER

Laboratory Demographics

CLIA Number: 27D2185022

Facility Name: VITALITY MEDICAL & WELLNESS CENTER

Facility Address:
1537 41ST ST. W.
BILLINGS, MT
ZIP 59102
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Facility Phone Number: 406 855-2422

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1942891205

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	27D2185022
LAB Type	Practitioner Other
Facility Name	VITALITY MEDICAL & WELLNESS CENTER
Street	1537 41ST ST. W.
City	BILLINGS
State	MT
ZIP	59102
Phone	406 855-2422
CertificateType	4
CertificateEffectiveDate	5/28/2022
CertificateExpirationDate	5/27/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024