| Vytalus Medical Group, Pllc | |
|
23330 Highway 59 N Ste 300 Kingwood TX 77339-4471 | |
| (281) 359-3223 | |
| (281) 359-2089 |
| Full Name | Vytalus Medical Group, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 23330 Highway 59 N Ste 300, Kingwood, Texas |
| Authorized Official Name and Position | Rachel E Tubbs (OFFICE MANAGER) |
| Authorized Official Contact | 2813593223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vytalus Medical Group, Pllc 23330 Highway 59 N Ste 300 Kingwood TX 77339-4471 Ph: (281) 359-3223 | Vytalus Medical Group, Pllc 23330 Highway 59 N Ste 300 Kingwood TX 77339-4471 Ph: (281) 359-3223 |
| NPI Number | 1053631275 |
|---|---|
| Provider Enumeration Date | 06/10/2010 |
| Last Update Date | 07/30/2024 |
| Medicare PECOS PAC ID | 9830215748 |
|---|---|
| Medicare Enrollment ID | O20100929000147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053631275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Allan H Daniels |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538265905 PECOS PAC ID: 7719028554 Enrollment ID: I20091230000656 |
| Provider Name | Martin Basaldua |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609809391 PECOS PAC ID: 7911981436 Enrollment ID: I20100929001290 |
| Provider Name | Carl S Heller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942225347 PECOS PAC ID: 3274517792 Enrollment ID: I20100929001316 |
| Provider Name | James Harry Phelan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811921448 PECOS PAC ID: 6507030590 Enrollment ID: I20111201000563 |
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