Provider Demographics
NPI:1104662279
Name:VITA TEMPUS, LLC
Entity type:Organization
Organization Name:VITA TEMPUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:769-348-3330
Mailing Address - Street 1:134 FAIRMONT ST STE C
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4739
Mailing Address - Country:US
Mailing Address - Phone:769-348-3330
Mailing Address - Fax:769-348-3351
Practice Address - Street 1:134 FAIRMONT ST STE C
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4739
Practice Address - Country:US
Practice Address - Phone:769-348-3330
Practice Address - Fax:769-348-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty