Provider Demographics
NPI:1649747247
Name:VIVE IV THERAPY
Entity Type:Organization
Organization Name:VIVE IV THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:563-284-2422
Mailing Address - Street 1:4855 ASBURY RD STE 7
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-0483
Mailing Address - Country:US
Mailing Address - Phone:563-284-2422
Mailing Address - Fax:
Practice Address - Street 1:4855 ASBURY RD STE 7
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-0483
Practice Address - Country:US
Practice Address - Phone:563-284-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy