Provider Demographics
NPI:1508565862
Name:VITRUVIAN CONSULTING GROUP LLC
Entity Type:Organization
Organization Name:VITRUVIAN CONSULTING GROUP LLC
Other - Org Name:MINDFUL INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-580-3806
Mailing Address - Street 1:39 ERIN DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8478
Mailing Address - Country:US
Mailing Address - Phone:847-716-0288
Mailing Address - Fax:
Practice Address - Street 1:1238 BLOOM RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-6765
Practice Address - Country:US
Practice Address - Phone:847-716-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty