Dr Agustin V Vitualla, MD is a
General Practice physician based in Camden, Tennessee. Dr Agustin V Vitualla is licensed to practice in Tennessee (license number 017177) and his current practice location is 135 Hospital Dr, Camden, Tennessee. He can be reached at his office (for appointments etc.) via phone at
(731) 584-2117.
NPI number for Dr Agustin V Vitualla is 1134217029 and his current mailing address is Po Box 625, 135 Hospital Dr, Camden, Tennessee. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1134217029.
Physician's Profile
| Full Name | Dr Agustin V Vitualla |
|---|
| Gender | Male |
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| Speciality | General Practice |
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| Location | 135 Hospital Dr, Camden, Tennessee |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1134217029
- Provider Enumeration Date: 10/10/2006
- Last Update Date: 10/20/2011
Medical Identifiers
Medical identifiers for Dr Agustin V Vitualla such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1134217029 | NPI | - | NPPES |
| 3021196 | Medicaid | TN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208D00000X | General Practice | 017177 (Tennessee) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Agustin V Vitualla is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Agustin V Vitualla, MD
Po Box 625, 135 Hospital Dr,
Camden, TN 38320
Ph: (731) 584-2117 | Dr Agustin V Vitualla, MD
135 Hospital Dr,
Camden, TN 38320
Ph: (731) 584-2117 |
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