NPIMap

Organization Active NPI

Vita Medical Care Clinic, PLLC

  • Family Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1619224144
Registry record updated Feb 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
VITA MEDICAL CARE CLINIC, PLLC
Practice address
2911 Breezewood Ave
Suite 101
Fayetteville, NC 28303
Phone
(910) 677-9488
Fax
(910) 677-9491
NPI assigned
Aug 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2017

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

Authorized official

Name
Lukisha D Purdie
Title
Practice Manager
Phone
(910) 677-9488

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Clinic/Center 261Q00000X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

2911 Breezewood Ave
Suite 101
Fayetteville, NC 28303

Mailing address

2911 Breezewood Ave
Suite 101
Fayetteville, NC 28303
Phone (910) 677-9488

National Provider Directory

National Provider Directory

Locations

345 Devers St
Fayetteville, NC 28303
Phone (910) 323-8482

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1344988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485993600000",
    "number": "1619224144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 BREEZEWOOD AVE",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28303",
            "telephone_number": "910-677-9488",
            "fax_number": "910-677-9491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 BREEZEWOOD AVE",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28303",
            "telephone_number": "910-677-9488",
            "fax_number": "910-677-9491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITA MEDICAL CARE CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-15",
        "last_updated": "2017-02-02",
        "status": "A",
        "authorized_official_last_name": "PURDIE",
        "authorized_official_first_name": "LUKISHA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "910-677-9488"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; 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.