Vitality Internal Medicine - Avondale PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

VITALITY INTERNAL MEDICINE - AVONDALE PLLC

Practice address

10320 W McDowell Rd Ste E5015
Avondale, AZ 85392-4869

Phone

(602) 791-9112

NPI assigned

Apr 17, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Charles Benjamin Evans II, MD

Title

Medical Director

Phone

(602) 791-9112

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Men's Vitality Center Other name
• Vitality Internal Medicine Other name

Locations

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1194212977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E DUNLAP AVE STE 1-193",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850207812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10320 W MCDOWELL RD STE E5015",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853924869",
            "telephone_number": "602-791-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY INTERNAL MEDICINE - AVONDALE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "602-791-9112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "37616",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Men's Vitality Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Vitality Internal Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Internal Medicine Physician in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.