MEDICARE: DR. KAVITA S VYAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	K9697	TX
2	207QA0505X	Adult Medicine Physician	K9697	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346246964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAVITA S VYAS M.D.

Provider Business Mailing Address
First Line	:	607 RUSSELL BLVD
Second Line	:	A
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1247
Country	:	US
Telephone Number	:	936-560-2920
Fax Number	:	866-861-6312

Provider Business Practice Location Address
First Line	:	607 RUSSELL BLVD
Second Line	:	A
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1247
Country	:	US
Telephone Number	:	936-560-2920
Fax Number	:	866-861-6312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/19/2017

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