NPIMap

Organization Active NPI

Vital Health Care LLC

  • Adult Medicine Physician
  • Peoria, AZ
National Provider Identifier
1396123733
Registry record updated May 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
2747 Issued in AZ
Legal business name
VITAL HEALTH CARE LLC
Practice address
7707 W Deer Valley Rd Ste 115
Peoria, AZ 85382-2101
Phone
(623) 218-1515
Fax
(623) 399-9958
NPI assigned
May 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2015

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

Authorized official

Name
Kevin Wray
Title
Owner
Phone
(623) 218-1515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0505X 2747 AZ Primary

Addresses

Primary practice location

7707 W Deer Valley Rd Ste 115
Peoria, AZ 85382-2101

Mailing address

7707 W Deer Valley Rd Ste 115
Peoria, AZ 85382-2101
Phone (623) 218-1515

Other identifiers 1

IdentifierTypeStateIssuer
2747OtherAZLICENSE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431907200000",
    "number": "1396123733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7707 W DEER VALLEY RD STE 115",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822101",
            "telephone_number": "623-218-1515",
            "fax_number": "623-399-9958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7707 W DEER VALLEY RD STE 115",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822101",
            "telephone_number": "623-218-1515",
            "fax_number": "623-399-9958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-18",
        "last_updated": "2015-05-18",
        "status": "A",
        "authorized_official_last_name": "WRAY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-218-1515"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AZ",
            "license": "2747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "2747",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2015; 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.