NPIMap

Organization Active NPI

Vitality Wellness Clinic LLC

Doing business as Vitality Medical Clinic and Spa

  • Specialist
  • D'Iberville, MS
National Provider Identifier
1760741698
Registry record updated Aug 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
20041 Issued in MS
Legal business name
VITALITY WELLNESS CLINIC LLC
Doing business as
Vitality Medical Clinic and Spa
Practice address
3200 Mallett Rd
D-3
D'Iberville, MS 39540-9305
Phone
(228) 392-0900
Fax
(228) 392-0902
NPI assigned
May 12, 2012
Last updated
Aug 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2012

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

Authorized official

Name
Dr. Jason Bradley Crowder, M.D.NPI 1114988086
Title
Owner
Phone
(251) 591-9769

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 20041 MS Primary

Addresses

Primary practice location

3200 Mallett Rd
D-3
D'Iberville, MS 39540-9305

Mailing address

3200 Mallett Rd
Suite D-3
D'Iberville, MS 39540-9305
Phone (228) 392-0900

Other names 1

  • Vitality Medical Clinic and Spa Doing business as

National Provider Directory

National Provider Directory

Locations

3200 Mallett Rd
#D3D
Diberville, MS 39540
Phone (228) 392-0900

3200 Mallett Rd
Ste D3
Diberville, MS 39540
Phone (228) 392-0900

Practitioners & affiliated clinicians

Practitioners 2

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": "1336780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1760741698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 MALLETT RD",
            "address_2": "SUITE D-3",
            "city": "D'IBERVILLE",
            "state": "MS",
            "postal_code": "395409305",
            "telephone_number": "228-392-0900",
            "fax_number": "228-392-0902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MALLETT RD",
            "address_2": "D-3",
            "city": "D'IBERVILLE",
            "state": "MS",
            "postal_code": "395409305",
            "telephone_number": "228-392-0900",
            "fax_number": "228-392-0902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-12",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "CROWDER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "251-591-9769",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "20041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitality Medical Clinic and Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in D'Iberville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; 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.