1316154073 NPI number — T. GOPAL & ASSOCIATES, M.D., P.A.

Table of content: (NPI 1316154073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316154073 NPI number — T. GOPAL & ASSOCIATES, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T. GOPAL & ASSOCIATES, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH BELT MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316154073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10594 FUQUA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77089-1402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-484-3500
Provider Business Mailing Address Fax Number:
281-484-3517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10594 FUQUA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77089-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-484-3500
Provider Business Practice Location Address Fax Number:
281-484-3517
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOPALAKRISHNAN
Authorized Official First Name:
THANDAVARAJAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-484-3500

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  K5966 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00506U . This is a "GROUP MC #T GOPAL & ASSOC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: I04507 . This is a "MC UPIN DR. BALASUBRAMANI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com