Vitality Internal Medicine - Phoenix PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

37616 Issued in AZ

Legal business name

VITALITY INTERNAL MEDICINE - PHOENIX PLLC

Practice address

4643 N 12TH St
Ste 101
Phoenix, AZ 85014-4006

Phone

(602) 626-8986

NPI assigned

Apr 21, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Charles B Evans II, MD

Title

Owner

Phone

(602) 791-9112

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1407200868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8776 E SHEA BLVD",
            "address_2": "STE B3A-129",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852606629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4643 N 12TH ST",
            "address_2": "STE 101",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850144006",
            "telephone_number": "602-626-8986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY INTERNAL MEDICINE - PHOENIX PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-21",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-791-9112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "37616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vitalis Medical LLC
• Vitalis Ventures LLC
• Vitality Advanced Mobile Healthcare PLLC
• Vitality Chiropractic and Wellness PLLC
• Vitality Clinical Laboratories PLLC
• Vitality LLC
• Vitality Psychological and Therapy Services PLLC
• Vitality Psychological Services LLC
• Vitalyze
• Milen Vitanov, D.M.D

• Primary Care Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Primary Care Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; 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.