VITALITY CLINICS OF EAST TEXAS, P.A. - NPI NUMBER 1508206442

Summary

Provider Name: VITALITY CLINICS OF EAST TEXAS, P.A.

NPI Number: 1508206442

Clasification: Family Medicine (207QA0505X)

Specialization: Adult Medicine

Address:
455 RICE RD
102
TYLER, TX
ZIP 75703

Phone Number: (903) 525-9432



Detailed Information

VITALITY CLINICS OF EAST TEXAS, P.A. is an adult family physician in Tyler, TX. The provider is definition to come. The assigned NPI number for this provider is 1508206442 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

455 RICE RD
102
TYLER, TX
ZIP 75703-604
Phone: (903) 525-9432
Fax: (903) 525-9455

The provider's authorized official is Steven Kip Yoder .
The authorized official title is Owner and has the following contact phone number (903) 525-9432.

The enumeration date for this NPI number is 6/25/2013 and was last updated on 6/25/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207QA0505X Family Medicine Adult Medicine Yes

NPI Record

No. Field Name Field Value
1 NPI 1508206442
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name VITALITY CLINICS OF EAST TEXAS, P.A.
5 Provider First Line Business Practice Location Address 455 RICE RD
6 Provider Second Line Business Practice Location Address 102
7 Provider Business Practice Location Address City Name TYLER
8 Provider Business Practice Location Address State Name TX
9 Provider Business Practice Location Address Postal Code 757033604
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 9035259432
12 Provider Business Practice Location Address Fax Number 9035259455
13 Provider Enumeration Date 6/25/2013
14 Last Update Date 6/25/2013
15 Authorized Official Last Name YODER
16 Authorized Official First Name STEVEN
17 Authorized Official Middle Name KIP
18 Authorized Official Title or Position OWNER
19 Authorized Official Telephone Number 9035259432
20 Healthcare Provider Taxonomy Code 1 207QA0505X
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text DR.
24 Authorized Official Credential Text M.D.
25 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 9/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.