1154313013 NPI number — SUBRAHMANYAM NARRA MD

Table of content: SUBRAHMANYAM NARRA MD (NPI 1154313013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154313013 NPI number — SUBRAHMANYAM NARRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NARRA
Provider First Name:
SUBRAHMANYAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NARRA
Provider Other First Name:
SAM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1154313013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12411 HYMEADOW DR STE 3E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78750-1829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-331-5321
Provider Business Mailing Address Fax Number:
512-251-6774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12411 HYMEADOW DR
Provider Second Line Business Practice Location Address:
STE 3E
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78750-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-331-5321
Provider Business Practice Location Address Fax Number:
512-331-8012
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  G6978 , 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: 46561 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4089872 . This is a "AETNA/TRS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300451 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060027797A . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060039605 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123207604 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0055RE . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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