Organization
VITALITY CARE CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARKE KRUGMAN NP (OWNER)
(928) 713-8385
Entity
Organization
Contact information
Practice address
1003 DIVISION ST STE 8, PRESCOTT, AZ 86301-1657
(928) 632-0730
Mailing address
7760 E. STATE ROUTE 69, SUITE C-5 BOX 360, PRESCOTT VALLEY, AZ 86314
(928) 225-2560
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
530064
—
AZ
Enumeration date
08/29/2019
Last updated
03/10/2020
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