Vitegent Healthcare Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

VITEGENT HEALTHCARE INC.

Doing business as

Petrified Forest Medical Center

Practice address

500 E Iowa St
Holbrook, AZ 86025-2750

Phone

(928) 524-3913

NPI assigned

Aug 28, 2019

Last updated

Sep 18, 2019By 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

Mr. Justin Hickman

Title

President and Ceo

Phone

(302) 724-6217

Specialties & licenses 5

Addresses

Other names 1

• Petrified Forest Medical Center Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568764800000",
    "number": "1215585807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 THE GRN STE 10294",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199013618",
            "telephone_number": "302-724-6217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E IOWA ST",
            "city": "HOLBROOK",
            "state": "AZ",
            "postal_code": "860252750",
            "telephone_number": "928-524-3913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITEGENT HEALTHCARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-28",
        "last_updated": "2019-09-18",
        "status": "A",
        "authorized_official_last_name": "HICKMAN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "302-724-6217",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "DrChrono",
            "affiliation": "N",
            "address_1": "500 E Iowa St",
            "city": "Holbrook",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "860252750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Petrified Forest Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Petrified Forest Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan Craig Stuart, O.D.
• V Craig Stuart, OD
• Summit Healthcare Medical Associates
• Edward Shane Trantham, FNP-C
• Nathan Velez, PH.D
• Margaret Abril Webb, LCSW

• Clinic/Center in Holbrook, AZ
• Providers in Holbrook, AZ by specialty
• Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.