Vitality Medical

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

VITALITY MEDICAL

Practice address

209 N Oak St
Sallisaw, OK 74955-4639

Phone

(918) 636-3930

Fax

(888) 422-2115

NPI assigned

May 26, 2017

Organization subpart

No

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

Authorized official

Name

Niko Koliastasis

Title

Ceo

Phone

(918) 636-3930

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

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

{
    "created_epoch": "1495756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578441600000",
    "number": "1962930503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 N OAK ST",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554639",
            "telephone_number": "918-503-6276",
            "fax_number": "918-503-6294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 N OAK ST",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554639",
            "telephone_number": "918-636-3930",
            "fax_number": "888-422-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-26",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A",
        "authorized_official_last_name": "KOLIASTASIS",
        "authorized_official_first_name": "NIKO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-636-3930"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeana Underwood, RN
• Stephanie Upchurch, M.A.
• Leexeng Vang
• Angelina Marie Velasquez, COTA
• Viewpoint Counseling Center, LLC
• Vitality Primary Care LLC
• Wal-Mart Stores East LP
• Alia Melissa Walker, P.A.-C
• Miriam Wall
• Betty Walters, BA

• Primary Care Clinic/Center in Sallisaw, OK
• Providers in Sallisaw, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.