Medical Vitality Clinic LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

MEDICAL VITALITY CLINIC LLC

Practice address

1845 Cordova Rd Ste 204
Fort Lauderdale, FL 33316-6100

Phone

(954) 361-3343

NPI assigned

Dec 20, 2019

Organization subpart

No

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

Authorized official

Name

Patricia Anson

Title

Delegated Offical

Phone

(305) 279-2276

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576800000000",
    "number": "1043858012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1845 CORDOVA RD STE 204",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333166100",
            "telephone_number": "954-361-3343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 CORDOVA RD STE 204",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333166100",
            "telephone_number": "954-361-3343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL VITALITY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-20",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A",
        "authorized_official_last_name": "ANSON",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "DELEGATED OFFICAL",
        "authorized_official_telephone_number": "305-279-2276"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Obstetrics & Gynecology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.