Organization
VITEGENT HEALTHCARE INC.
Active
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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