Vitality Medical Services, PLLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

39460 Issued in NC

Legal business name

VITALITY MEDICAL SERVICES, PLLC

Practice address

2632 Fines Creek Dr
Statesville, NC 28625-4441

Phone

(704) 728-9509

NPI assigned

Oct 17, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Richard Pavelock, MDNPI 1487739579

Title

Owner

Phone

(704) 880-8665

Specialties & licenses 2

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard M Pavelock, MD

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Statesville, NC
  • NPI 1487739579
  NPD (past) Authorized official

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

{
    "created_epoch": "1445040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445040000000",
    "number": "1508237496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2632 FINES CREEK DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2632 FINES CREEK DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254441",
            "telephone_number": "704-728-9509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY MEDICAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-17",
        "last_updated": "2015-10-17",
        "status": "A",
        "authorized_official_last_name": "PAVELOCK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-880-8665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "NC",
            "license": "39460",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MEDICAL BOARD CERTIFICATE",
            "identifier": "196006",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8966248",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Esmeralda Vega Luna
• Erica L Velez, LMSW
• Leah Chamblin Vestal
• Kristen Vestigo, PA-C
• Candace N Viada, PHARMD
• Elliott Jonathan Vizel, M.D.
• Valencia Sue Von Dran, LPC, LCAS
• Karen L. Voorhees, CRNA
• Menelaos Voulgaropoulos, M.D.
• Jamila Aisha Wade, M.D.

• General Practice Physician in Statesville, NC
• Providers in Statesville, NC by specialty
• General Practice Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2015; 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.