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General NPI Number Information
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NPI Number | 1558829887
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Entity Type | Organization
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Legal Business Name | VT MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 412 S MORGAN ST
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City | GRANBURY
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State | TX
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Zip | 76048-1958
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Country | US
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Telephone | 281-816-4844
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Fax | 281-816-4818
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Provider Business Mailing Address
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Address Line | 412 S MORGAN ST
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City | GRANBURY
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State | TX
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Zip | 76048-1958
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Country | US
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Telephone | 281-816-4844
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Fax | 281-816-4818
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DEBORAH RICHES
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Credential |
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Telephone | 281-816-4844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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