Vitality Care Center PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

VITALITY CARE CENTER PLLC

Practice address

1003 Division St Ste 8
Prescott, AZ 86301-1657

Phone

(928) 632-0730

NPI assigned

Aug 29, 2019

Last updated

Mar 10, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Clarke Krugman, NP

Title

Owner

Phone

(928) 713-8385

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1567036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1114575578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7760 E. STATE ROUTE 69",
            "address_2": "SUITE C-5 BOX 360",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "86314",
            "telephone_number": "928-225-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 DIVISION ST STE 8",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011657",
            "telephone_number": "928-632-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY CARE CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-29",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "KRUGMAN",
        "authorized_official_first_name": "CLARKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-713-8385",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "530064",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chad Jason Vernon, OT
• Suzie Alexandra Viaud, FNP
• Vigilant Medical Care, LLC
• Virginia Lea Conner PLLC
• Vision Diagnostics, LLC
• Victoria Truong Vo, MD
• Robert Volpicelli
• Stephanie M. Voss, SPEECH THERAPIST
• Waara Family Medicine, LLC
• James H Waara, PHARM D

• Family Medicine Physician in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; 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.