Healthcare Provider Details

I. General information

NPI: 1053909705
Provider Name (Legal Business Name): VITALCARE TELEMEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15957 PUNTA ESPADA LOOP
CORPUS CHRISTI TX
78418-6626
US

IV. Provider business mailing address

14493 S PADRE ISLAND DR STE A-5012
CORPUS CHRISTI TX
78418-5931
US

V. Phone/Fax

Practice location:
  • Phone: 361-214-6367
  • Fax: 779-204-4430
Mailing address:
  • Phone: 361-214-6367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM JOSEPH STITH JR.
Title or Position: COLLABORATIVE PHYSICIAN
Credential: DO
Phone: 361-904-3637