Provider Demographics
NPI:1629883749
Name:VYTAL MEDICAL GROUP LLC
Entity type:Organization
Organization Name:VYTAL MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-481-9650
Mailing Address - Street 1:1 N 1ST ST STE 700
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2364
Mailing Address - Country:US
Mailing Address - Phone:602-481-9650
Mailing Address - Fax:
Practice Address - Street 1:1 N 1ST ST STE 700
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2364
Practice Address - Country:US
Practice Address - Phone:602-481-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care