BALANCED VITALITY LLC NPI 1306574520

NPI Information

NPI: 1306574520
Provider Name: BALANCED VITALITY LLC
Classification: Clinic/Center - 261QH0100X
Specialization: Health Service
Entity Type: Organization
Address: 1125 E 2ND ST
CASPER, WY
ZIP 82601
Phone: (307) 577-4225

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NPI Details

BALANCED VITALITY LLC is a health service clinic center in Casper, WY. BALANCED VITALITY LLC NPI is 1306574520. The provider is registered as an organization entity type.

The provider's business location address is:

1125 E 2ND ST
CASPER, WY
ZIP 82601-903
Phone: (307) 577-4225
Fax: (307) 577-4229

The provider's authorized official is Debbie Porter .
The authorized official title is Office Manager and has the following contact phone number (307) 577-4225.

The enumeration date for this NPI number is 8/15/2022 and was last updated on 8/15/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0100X	Clinic/Center	Health Service			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1477894756	MEDICAID	WYOMING
2	1013083740	MEDICAID	WYOMING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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