Healthcare Provider Details

I. General information

NPI: 1619832987
Provider Name (Legal Business Name): VYTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S 500 W STE 226
SALT LAKE CITY UT
84101-2382
US

IV. Provider business mailing address

650 S 500 W STE 226
SALT LAKE CITY UT
84101-2382
US

V. Phone/Fax

Practice location:
  • Phone: 385-955-0055
  • Fax:
Mailing address:
  • Phone: 385-955-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY POLMATEER
Title or Position: COO
Credential:
Phone: 385-201-0999