Provider Demographics
NPI:1376583609
Name:TOTAL VITALITY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:TOTAL VITALITY MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-726-1460
Mailing Address - Street 1:24945 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-3927
Mailing Address - Country:US
Mailing Address - Phone:727-726-1460
Mailing Address - Fax:727-724-9705
Practice Address - Street 1:24945 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-3927
Practice Address - Country:US
Practice Address - Phone:727-726-1460
Practice Address - Fax:727-724-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6641Medicare PIN