Provider Type Icon

VITALITY CARE CENTER PLLC NPI 1114575578


NPI Information

NPI: 1114575578
Provider Name: VITALITY CARE CENTER PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
1003 DIVISION ST STE 8
PRESCOTT, AZ
ZIP 86301
Phone: (928) 632-0730
Get Directions

VITALITY CARE CENTER PLLC is a family medicine in Prescott, AZ. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. VITALITY CARE CENTER PLLC NPI is 1114575578. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1003 DIVISION ST STE 8
PRESCOTT, AZ
ZIP 86301-657
Phone: (928) 632-0730

The provider's authorized official is Clarke Krugman .
The authorized official title is Owner and has the following contact phone number (928) 713-8385.

The enumeration date for this NPI number is 8/29/2019 and was last updated on 3/10/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1530064MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.