Provider Demographics
NPI:1053631275
Name:VYTALUS MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:VYTALUS MEDICAL GROUP, PLLC
Other - Org Name:DIAGNOSTIC AFFILIATES OF NORTHEAST HOUSTON, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-359-3223
Mailing Address - Street 1:23330 HIGHWAY 59 N STE 300
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4471
Mailing Address - Country:US
Mailing Address - Phone:281-359-3223
Mailing Address - Fax:281-359-2089
Practice Address - Street 1:23330 HIGHWAY 59 N STE 300
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4471
Practice Address - Country:US
Practice Address - Phone:281-359-3223
Practice Address - Fax:281-359-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty