Vitality Family Healthcare, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

VITALITY FAMILY HEALTHCARE, LLC

Doing business as

Vitality Family Healthcare

Practice address

1028 N Webb Rd Ste E
Grand Island, NE 68803-3318

Phone

(308) 865-0703

Fax

(308) 865-0703

NPI assigned

Feb 6, 2023

Last updated

Feb 6, 2023By 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

Dr. Jacob Christopher Peterson, MD

Title

Ceo, Physician

Phone

(308) 865-0703

Specialties & licenses 4

Addresses

Other names 1

• Vitality Family Healthcare Doing business as

Locations

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

{
    "created_epoch": "1675641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675641600000",
    "number": "1851097406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 WEST AVE",
            "city": "HOLDREGE",
            "state": "NE",
            "postal_code": "689492226",
            "telephone_number": "308-865-0703",
            "fax_number": "308-865-0703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 N WEBB RD STE E",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688033318",
            "telephone_number": "308-865-0703",
            "fax_number": "308-865-0703"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "521 West Ave",
            "address_purpose": "LOCATION",
            "city": "Holdrege",
            "state": "NE",
            "postal_code": "689492226",
            "country_code": "US",
            "telephone_number": "308-865-0703",
            "fax_number": "308-865-0703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITALITY FAMILY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-06",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO, PHYSICIAN",
        "authorized_official_telephone_number": "308-865-0703",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitality Family Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Family Medicine Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; 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.