Provider Demographics
NPI:1053909705
Name:VITALCARE TELEMEDICINE LLC
Entity type:Organization
Organization Name:VITALCARE TELEMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLABORATIVE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:361-904-3637
Mailing Address - Street 1:14493 S PADRE ISLAND DR STE A-5012
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5931
Mailing Address - Country:US
Mailing Address - Phone:361-214-6367
Mailing Address - Fax:
Practice Address - Street 1:15957 PUNTA ESPADA LOOP
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6626
Practice Address - Country:US
Practice Address - Phone:361-214-6367
Practice Address - Fax:779-204-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1760678940OtherNPI