VITALITY CLINICS OF EAST TEXAS, P.A. - NPI NUMBER 1508206442
Provider Name: VITALITY CLINICS OF EAST TEXAS, P.A.
NPI Number: 1508206442
Clasification: Family Medicine (207QA0505X)
Specialization: Adult Medicine
455 RICE RD
Phone Number: (903) 525-9432
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
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
The following information regarding the scope of practice of this provider is available:
||Entity Type Code
||Employer Identification Number EIN
||Provider Organization Name Legal Business Name
||VITALITY CLINICS OF EAST TEXAS, P.A.
||Provider First Line Business Practice Location Address
||455 RICE RD
||Provider Second Line Business Practice Location Address
||Provider Business Practice Location Address City Name
||Provider Business Practice Location Address State Name
||Provider Business Practice Location Address Postal Code
||Provider Business Practice Location Address Country Code If outside U S
||Provider Business Practice Location Address Telephone Number
||Provider Business Practice Location Address Fax Number
||Provider Enumeration Date
||Last Update Date
||Authorized Official Last Name
||Authorized Official First Name
||Authorized Official Middle Name
||Authorized Official Title or Position
||Authorized Official Telephone Number
||Healthcare Provider Taxonomy Code 1
||Healthcare Provider Primary Taxonomy Switch 1
||Is Organization Subpart
||Authorized Official Name Prefix Text
||Authorized Official Credential Text
||Healthcare Provider Taxonomy Group 1
||193400000X SINGLE SPECIALTY GROUP
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This page was last updated on: 10/12/2014
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