NPIMap

Organization Active NPI

Vitalis Specialty Group LLC

  • Nurse Practitioner
  • San Antonio, TX
National Provider Identifier
1205675121
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
VITALIS SPECIALTY GROUP LLC
Practice address
21411 US Highway 281 S
San Antonio, TX 78264-4824
Phone
(210) 844-7550
NPI assigned
May 21, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Authorized official

Name
Andrew Thomas Vidal, FNPNPI 1194264531
Title
Owner
Phone
(210) 844-7550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

21411 US Highway 281 S
San Antonio, TX 78264-4824

Mailing address

21411 US Highway 281 S
San Antonio, TX 78264-4824
Phone (210) 844-7550

National Provider Directory

National Provider Directory

Locations

8235 S New Braunfels
Ste 201
San Antonio, TX 78235
Phone (210) 504-5053

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1716249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716249600000",
    "number": "1205675121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21411 US HIGHWAY 281 S",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782644824",
            "telephone_number": "210-844-7550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21411 US HIGHWAY 281 S",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782644824",
            "telephone_number": "210-844-7550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALIS SPECIALTY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-21",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A",
        "authorized_official_last_name": "VIDAL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-844-7550",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; 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.