New Vitality Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

NEW VITALITY CLINIC

Practice address

1207 N Virginia St
Port Lavaca, TX 77979-2506

Phone

(361) 746-1588

Fax

(361) 400-5310

NPI assigned

May 2, 2014

Last updated

May 2, 2014By 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

Dr. Gustavo Adolfo Gross, MD

Title

Owner

Phone

(830) 491-2151

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Gary S Cook, P.A.

  • Medical Physician Assistant
  • Port Lavaca, TX
  • NPI 1154325611
  NPD (past)

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

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398988800000",
    "number": "1285044057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779792506",
            "telephone_number": "361-746-1588",
            "fax_number": "361-400-5310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779792506",
            "telephone_number": "361-746-1588",
            "fax_number": "361-400-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW VITALITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-02",
        "last_updated": "2014-05-02",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "GUSTAVO",
        "authorized_official_middle_name": "ADOLFO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-491-2151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC NUMBER",
            "identifier": "00886",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vrinda Mohunta
• Ngale Ndiva Mongoh, PHARM.D
• Hector Morales
• Shirley Ann Mumphord, LPC
• Adam Nicholas Myers, CRNA
• Rhonda Kay Nielsen, D.D.S.
• Tasha Norman, MSN, APRN, FNP-C
• Nra-Port Lavaca, Texas, LLC
• Bryce Allen O'Donnell, DDS
• Shanna Suzanne Odonnell, FNP

• Clinic/Center in Port Lavaca, TX
• Providers in Port Lavaca, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2014; 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.