Vitality Primary Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

VITALITY PRIMARY CARE LLC

Practice address

209 N Oak St
Sallisaw, OK 74955-4639

Phone

(918) 636-3930

Fax

(918) 636-3930

NPI assigned

May 26, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Niko Koliastasis

Title

Ceo

Phone

(918) 636-3930

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495756800000",
    "number": "1023546660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 N OAK ST",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554639",
            "telephone_number": "918-636-3930",
            "fax_number": "188-422-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 N OAK ST",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554639",
            "telephone_number": "918-636-3930",
            "fax_number": "918-636-3930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-26",
        "last_updated": "2017-05-26",
        "status": "A",
        "authorized_official_last_name": "KOLIASTASIS",
        "authorized_official_first_name": "NIKO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-636-3930"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Upchurch, M.A.
• Leexeng Vang
• Angelina Marie Velasquez, COTA
• Viewpoint Counseling Center, LLC
• Vitality Medical
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0047)
• Alia Melissa Walker, P.A.-C
• Miriam Wall
• Betty Walters, BA
• Ricky Walters

• Primary Care Clinic/Center in Sallisaw, OK
• Providers in Sallisaw, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.