NPIMap

Organization Active NPI

VMG, LLC

  • Specialist
  • Mesa, AZ
National Provider Identifier
1093043531
Registry record updated Nov 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
29241 Issued in AZ
Legal business name
VMG, LLC
Practice address
1111 S Stapley Dr
Suite 111
Mesa, AZ 85204-5059
Phone
(480) 398-1220
Fax
(480) 983-1230
NPI assigned
Nov 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2009

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

Authorized official

Name
Ms. Shannon Gray
Title
Owner/Administrator
Phone
(480) 983-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 29241 AZ Primary

Addresses

Primary practice location

1111 S Stapley Dr
Suite 111
Mesa, AZ 85204-5059

Mailing address

212 W Superstition Blvd
Suite 101
Apache Junction, AZ 85120-4127
Phone (480) 983-4200

Other names 1

  • VISTA MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Vista Medical Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1111 S Stapley Dr
Ste 111
Mesa, AZ 85204
Phone (480) 398-1220

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1258675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1093043531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 W SUPERSTITION BLVD",
            "address_2": "SUITE 101",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851204127",
            "telephone_number": "480-983-4200",
            "fax_number": "480-983-4317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 S STAPLEY DR",
            "address_2": "SUITE 111",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852045059",
            "telephone_number": "480-398-1220",
            "fax_number": "480-983-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VMG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-20",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "480-983-4200",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "AZ",
            "license": "29241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VISTA MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; 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.