Provider Demographics
NPI:1194317834
Name:VHI MEDICAL GROUP, PA
Entity type:Organization
Organization Name:VHI MEDICAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KETEYIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:488-911-2682
Mailing Address - Street 1:38 MONTVALE AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2446
Mailing Address - Country:US
Mailing Address - Phone:248-891-1268
Mailing Address - Fax:
Practice Address - Street 1:6416 SHERMAN PEAK CT
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9492
Practice Address - Country:US
Practice Address - Phone:248-891-1268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty