Organization
VITEGENT HEALTHCARE INC.
Active
Other names
Petrified Forest Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN HICKMAN (PRESIDENT AND CEO)
(302) 724-6217
Entity
Organization
Contact information
Practice address
500 E IOWA ST, HOLBROOK, AZ 86025-2750
(928) 524-3913
Mailing address
8 THE GRN STE 10294, DOVER, DE 19901-3618
(302) 724-6217
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
Other
Enumeration date
08/28/2019
Last updated
09/18/2019
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