Active NPI
Vitalskin Medical Group Il PLLC
- Dermatology Physician
- New Albany, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- VITALSKIN MEDICAL GROUP IL PLLC
- Practice address
- 2857 Charlestown Rd Ste 100
New Albany, IN 47150-1998 - Phone
- (812) 944-7500
- NPI assigned
- Apr 15, 2022
- Last updated
- Aug 12, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dan Wiens
- Title
- Chief Financial Officer
- Phone
- (704) 534-1854
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | NU | Primary |
Addresses
Primary practice location
2857 Charlestown Rd Ste 100
New Albany, IN 47150-1998
Mailing address
1111 W Kenyon Rd
Urbana, IL 61801-1010
Phone (858) 735-4059
Other practice location 1
825 University Woods Dr Ste 8
New Albany, IN 47150-2427
Phone (812) 944-7500
National Provider Directory
National Provider Directory- Tax ID family
- Vitalskin Medical Group Il PLLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dermatopathology Physician
- Saint Louis, MO
- NPI 1881384915
Locations
825 University Woods Dr
Ste 8
New Albany, IN 47150
Phone (812) 944-7500
Practitioners & affiliated clinicians
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.
-
- Family Nurse Practitioner
- Decatur, IL
- NPI 1366605347
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649980800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1723420800000",
"number": "1639812811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 W KENYON RD",
"city": "URBANA",
"state": "IL",
"postal_code": "618011010",
"telephone_number": "858-735-4059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2857 CHARLESTOWN RD STE 100",
"city": "NEW ALBANY",
"state": "IN",
"postal_code": "471501998",
"telephone_number": "812-944-7500"
}
],
"practiceLocations": [
{
"address_1": "825 University Woods Dr Ste 8",
"address_purpose": "LOCATION",
"city": "New Albany",
"state": "IN",
"postal_code": "471502427",
"country_code": "US",
"telephone_number": "812-944-7500",
"fax_number": "819-944-4656",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "VITALSKIN MEDICAL GROUP IL PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-04-15",
"last_updated": "2024-08-12",
"certification_date": "2024-08-12",
"status": "A",
"authorized_official_last_name": "WIENS",
"authorized_official_first_name": "DAN",
"authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "704-534-1854"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Albany, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.