MEDICARE: NEW VITALITY CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00886	OTHER	TX	STATE LIC NUMBER

General Provider Information

NPI Number	:	1285044057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VITALITY CLINIC

Provider Business Mailing Address
First Line	:	1207 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2506
Country	:	US
Telephone Number	:	361-746-1588
Fax Number	:	361-400-5310

Provider Business Practice Location Address
First Line	:	1207 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2506
Country	:	US
Telephone Number	:	361-746-1588
Fax Number	:	361-400-5310

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GUSTAVO ADOLFO GROSS
Credential	:	MD
Telephone Number	:	830-491-2151

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	05/02/2014

Similar Medicare Providers

1154325611 — MR. GARY S COOK P.A.
Practice Location Address:

1207 N VIRGINIA ST
PORT LAVACA, TX
77979-2506

Practice Phone: 361-746-1588
Practice Fax: 361-400-1588

1811992050 — DR. MARC JEFFREY MALLIS MD
Practice Location Address:

5347 MAIN ST , STE 102
NEW PORT RICHEY, FL
34652-2506

Practice Phone: 727-845-1343
Practice Fax: 727-845-1343

1144321571 — RETINA VITROUS CONSULTANTS OF WEST FLORIDA PL
Practice Location Address:

5347 MAIN ST , SUITE 102
NEW PORT RICHEY, FL
34652-2506

Practice Phone: 727-845-1343
Practice Fax: 727-842-9523

1811084783 — F.A. HAUBER ,M.D., P.A.
Practice Location Address:

5347 MAIN STREET , SUITE 100
NEW PORT RICHEY, FL
34652-2506

Practice Phone: 727-847-4448
Practice Fax: 727-845-1572

1902930563 — DR. BARBARA G MORGAN D.M.D.,P.A.
Practice Location Address:

5347 MAIN ST , SUITE 301
NEW PORT RICHEY, FL
34652-2506

Practice Phone: 727-841-9800
Practice Fax: 727-848-4768

1366600421 — ADVANCED PHYSICIAN SPECIALISTS
Practice Location Address:

5347 MAIN ST , SUITE 203
NEW PORT RICHEY, FL
34652-2506

Practice Phone: 727-849-6690
Practice Fax:

Directions to “NEW VITALITY CLINIC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.