Vital Med LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

VITAL MED LLC

Practice address

103 Ridgemont Villa
Booneville, MS 38829-1010

Phone

(662) 368-3858

Fax

(662) 368-3931

NPI assigned

Jan 23, 2020

Organization subpart

No

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

Authorized official

Name

Desiree Brooke Haugh, NP

Title

Owner/NP

Phone

(662) 368-3858

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1710517347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 RIDGEMONT VILLA",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388291010",
            "telephone_number": "662-368-3858",
            "fax_number": "662-368-3931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 RIDGEMONT VILLA",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388291010",
            "telephone_number": "662-368-3858",
            "fax_number": "662-368-3931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL MED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-23",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "HAUGH",
        "authorized_official_first_name": "DESIREE",
        "authorized_official_middle_name": "BROOKE",
        "authorized_official_title_or_position": "OWNER/NP",
        "authorized_official_telephone_number": "662-368-3858",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02056754",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Margaret Anne Wait, NP
• Wal-Mart Stores East LP
• Tiara L Walker
• Kristin Green Wesson, LPC
• Wheeler Clinic Inc.

• Primary Care Clinic/Center in Booneville, MS
• Providers in Booneville, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.