Provider Demographics
NPI:1003615469
Name:VITZTHUM, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:VITZTHUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N 1ST ST STE C
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-9252
Mailing Address - Country:US
Mailing Address - Phone:870-356-7404
Mailing Address - Fax:
Practice Address - Street 1:408 N 1ST ST STE C
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:AR
Practice Address - Zip Code:71943-9252
Practice Address - Country:US
Practice Address - Phone:870-356-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator