| Vitality Care Center Pllc | |
|
1003 Division St Ste 8 Prescott AZ 86301-1657 | |
| (928) 632-0730 | |
| Not Available |
| Full Name | Vitality Care Center Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1003 Division St Ste 8, Prescott, Arizona |
| Authorized Official Name and Position | Clarke Krugman (OWNER) |
| Authorized Official Contact | 9287138385 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Care Center Pllc 7760 E. State Route 69 Suite C-5 Box 360 Prescott Valley AZ 86314 Ph: (928) 225-2560 | Vitality Care Center Pllc 1003 Division St Ste 8 Prescott AZ 86301-1657 Ph: (928) 632-0730 |
| NPI Number | 1114575578 |
|---|---|
| Provider Enumeration Date | 08/29/2019 |
| Last Update Date | 03/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114575578 | NPI | - | NPPES |
| 530064 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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