1194317834 NPI number — VHI MEDICAL GROUP, PA

Table of content: (NPI 1194317834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194317834 NPI number — VHI MEDICAL GROUP, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VHI MEDICAL GROUP, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194317834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 MONTVALE AVE STE 315
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STONEHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02180-2446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-891-1268
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6416 SHERMAN PEAK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE PINES
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80108-9492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-891-1268
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KETEYIAN
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
488-911-2682

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)