Healthcare Provider Details

I. General information

NPI: 1801912720
Provider Name (Legal Business Name): VMG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W SUPERSTITION BLVD SUITE 101
APACHE JUNCTION AZ
85220-4127
US

IV. Provider business mailing address

212 W SUPERSTITION BLVD SUITE 101
APACHE JUNCTION AZ
85220-4127
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-4200
  • Fax:
Mailing address:
  • Phone: 480-983-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANNON GRAY
Title or Position: MEMBER PRACTICE MANAGER
Credential:
Phone: 480-983-4200