Provider Demographics
NPI:1104490671
Name:SYNOVATION MEDICAL GROUP TEXAS, PLLC
Entity type:Organization
Organization Name:SYNOVATION MEDICAL GROUP TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:VARGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-428-7730
Mailing Address - Street 1:10565 CIVIC CENTER DR BLDG STE 250
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3853
Mailing Address - Country:US
Mailing Address - Phone:626-696-1481
Mailing Address - Fax:626-696-1451
Practice Address - Street 1:1518 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4405
Practice Address - Country:US
Practice Address - Phone:940-253-7160
Practice Address - Fax:833-460-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty