MEDICARE: SVETLANA VITUS

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	207Q00000X	Family Medicine Physician	202010121NP-PP	OR

General Provider Information

NPI Number	:	1154912632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA VITUS

Provider Business Mailing Address
First Line	:	1701 NE 7TH ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1319
Country	:	US
Telephone Number	:	541-471-4106
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 1ST ST
Second Line	:
City	:	GLENDALE
State	:	OR
Zip	:	97442-9640
Country	:	US
Telephone Number	:	541-832-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	04/19/2021

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Directions to “ SVETLANA VITUS ” Practice Location

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