NPIMap

Organization Active NPI

Vitality Internal Medicine - Tempe LLC

  • Primary Care Clinic/Center
  • Tempe, AZ
National Provider Identifier
1669760203
Registry record updated Jul 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
37616 Issued in AZ
Legal business name
VITALITY INTERNAL MEDICINE - TEMPE LLC
Practice address
4653 S Lakeshore Dr Ste 2
Tempe, AZ 85282-7161
Phone
(480) 456-8981
NPI assigned
Jul 18, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2011

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

Authorized official

Name
Dr. Charles Benjamin Evans II, M.D.
Title
Owner
Phone
(602) 791-9112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 37616 AZ Primary

Addresses

Primary practice location

4653 S Lakeshore Dr Ste 2
Tempe, AZ 85282-7161

Mailing address

5509 E Friess Dr
Scottsdale, AZ 85254-2966

Other names 1

  • Mens Vitality Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310947200000",
    "number": "1669760203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5509 E FRIESS DR",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852542966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4653 S LAKESHORE DR STE 2",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827161",
            "telephone_number": "480-456-8981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY INTERNAL MEDICINE - TEMPE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-18",
        "last_updated": "2011-07-18",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "BENJAMIN",
        "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": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "37616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mens Vitality Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; 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.