| Organization Name: | VANGUARD PHYSICIAN GROUP LLC |
| NPI Number: | 1295038297 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KHALID SHIRIF (SOLE MEMBER) |
| Mailing Address: | 1840 E University Dr Suite 6 Mesa |
| State: | AZ US |
| Postal Code: | 852038237 |
| Phone Number: | 4802682670 |
| Fax Number: | 4802682671 |
| NPI Enumeration Date: | 12/13/2010 |
| NPI Last Update Date: | 12/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | HSPC4985 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |