NPIMap

Organization Active NPI

Vitality Aesthetics PLLC

Doing business as Vitality Aesthetics

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1710427174
Registry record updated Mar 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
43176 Issued in CO
Legal business name
VITALITY AESTHETICS PLLC
Doing business as
Vitality Aesthetics
Practice address
7680 Goddard St
Suite 100
Colorado Springs, CO 80920-8235
Phone
(719) 502-9779
Fax
(719) 418-6172
NPI assigned
Mar 6, 2017
Last updated
Mar 6, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
WOODLAND PARK FAMILY MEDICINE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2017

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

Authorized official

Name
Dr. Matthew C Young, MD
Title
Owner
Phone
(719) 502-9779

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 43176 CO Primary

Addresses

Primary practice location

7680 Goddard St
Suite 100
Colorado Springs, CO 80920-8235

Mailing address

7680 Goddard St
Suite 100
Colorado Springs, CO 80920-8235
Phone (719) 502-9779

Other names 1

  • Vitality Aesthetics Doing business as

National Provider Directory

National Provider Directory
Part of
Woodland Park Fam Med LLC

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488758400000",
    "number": "1710427174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7680 GODDARD ST",
            "address_2": "SUITE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809208235",
            "telephone_number": "719-502-9779",
            "fax_number": "719-418-6172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7680 GODDARD ST",
            "address_2": "SUITE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809208235",
            "telephone_number": "719-502-9779",
            "fax_number": "719-418-6172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY AESTHETICS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WOODLAND PARK FAMILY MEDICINE LLC",
        "enumeration_date": "2017-03-06",
        "last_updated": "2017-03-06",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-502-9779",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "43176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitality Aesthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.