Provider Demographics
NPI:1528255601
Name:VYAS & VYAS MD PC
Entity type:Organization
Organization Name:VYAS & VYAS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YONGKUMA
Authorized Official - Middle Name:CALEB
Authorized Official - Last Name:YONGKUMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-222-6041
Mailing Address - Street 1:1212 EAST THREE NOTCH STREET
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420
Mailing Address - Country:US
Mailing Address - Phone:334-222-6041
Mailing Address - Fax:334-222-1595
Practice Address - Street 1:1212 EAST THREE NOTCH STREET
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420
Practice Address - Country:US
Practice Address - Phone:334-222-6041
Practice Address - Fax:334-222-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000109308Medicaid
AL000109308Medicaid
AL102I113291Medicare PIN