MEDICARE: VITALITY HEALTH GROUP INC

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	12100	AZ

General Provider Information

NPI Number	:	1316265242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY HEALTH GROUP INC

Provider Business Mailing Address
First Line	:	17220 N BOSWELL BLVD
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-2000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17220 N BOSWELL BLVD
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-2000
Country	:	US
Telephone Number	:	602-789-4120
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFFREY CARLS
Credential	:
Telephone Number	:	602-789-4120

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/17/2010

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