Provider Demographics
NPI:1518232297
Name:VIVE HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:VIVE HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-756-5565
Mailing Address - Street 1:PO BOX 17504
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-0504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5309 VILLAGE PKWY
Practice Address - Street 2:SUITE 3
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8102
Practice Address - Country:US
Practice Address - Phone:901-756-5565
Practice Address - Fax:901-756-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty