MEDICARE: VYTA LLC

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	261QI0500X	Infusion Therapy Clinic/Center
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1619832987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VYTA LLC

Provider Business Mailing Address
First Line	:	650 S 500 W STE 226
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2382
Country	:	US
Telephone Number	:	385-955-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 S 500 W STE 226
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2382
Country	:	US
Telephone Number	:	385-955-0055
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	TIFFANY POLMATEER
Credential	:
Telephone Number	:	385-201-0999

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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Directions to “VYTA LLC ” Practice Location

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