Provider Demographics
NPI:1851083695
Name:VYVO THERAPEUTICS
Entity Type:Organization
Organization Name:VYVO THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-218-8054
Mailing Address - Street 1:2817 W LOOP 250 N STE A
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3205
Mailing Address - Country:US
Mailing Address - Phone:432-218-8054
Mailing Address - Fax:
Practice Address - Street 1:2817 W LOOP 250 N STE A
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3205
Practice Address - Country:US
Practice Address - Phone:432-218-8054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1669842118Medicaid
TX1619322492Medicaid