1386039360 NPI number — MD GASTROENTEROLOGY ANESTHESIA SERVICES, PLLC

Table of content: (NPI 1386039360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386039360 NPI number — MD GASTROENTEROLOGY ANESTHESIA SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MD GASTROENTEROLOGY ANESTHESIA SERVICES, PLLC
Provider Last Name:
Provider First Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1386039360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25230 KINSLAND BLVD
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-2097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-429-4828
Provider Business Mailing Address Fax Number:
713-429-4866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25230 KINSLAND BLVD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77494-2097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-429-4828
Provider Business Practice Location Address Fax Number:
713-429-4866
Provider Enumeration Date:
04/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
TAMERISA
Authorized Official First Name:
RADHA
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MBR
Authorized Official Telephone Number:
713-540-8997

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  L7210 , 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)





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