Vitality M12 LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

VITALITY M12 LLC

Practice address

4650 Arville St Ste F
Las Vegas, NV 89103-5325

Phone

(702) 240-8531

Fax

(702) 441-1765

NPI assigned

Apr 21, 2020

Last updated

Apr 21, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexandra Stabile

Title

Controller

Phone

(702) 240-8531

Specialties & licenses 1

Addresses

Other names 1

• Vitality MGM LLC Former legal business name

Locations

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1205456001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 ARVILLE ST STE F",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891035325",
            "telephone_number": "702-240-8531",
            "fax_number": "702-441-1765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 ARVILLE ST STE F",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891035325",
            "telephone_number": "702-240-8531",
            "fax_number": "702-441-1765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY M12 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-21",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "STABILE",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "702-240-8531"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitality MGM LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Durable Medical Equipment & Medical Supplies in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; 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.