1447237243 NPI number — DR. PRAMODA K MOHAPATRA M.D.

Table of content: DR. PRAMODA K MOHAPATRA M.D. (NPI 1447237243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447237243 NPI number — DR. PRAMODA K MOHAPATRA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOHAPATRA
Provider First Name:
PRAMODA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1447237243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 UNIVERSITY DRIVE EAST - SUITE 100
Provider Second Line Business Mailing Address:
BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Provider Business Mailing Address City Name:
COLLEGE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-846-1100
Provider Business Mailing Address Fax Number:
979-260-9390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 FM 1488 ROAD
Provider Second Line Business Practice Location Address:
HEALTH POINT HEMPSTEAD
Provider Business Practice Location Address City Name:
HEMPSTEAD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77445-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-826-8200
Provider Business Practice Location Address Fax Number:
979-826-8210
Provider Enumeration Date:
12/22/2005

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: 207Q00000X , with the licence number:  L7280 , 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: 1635237-08 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74-1868 . This is a "PTAN HEALTH POINT HEMPSTEAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1821185299 . This is a "BVCAA, INC. - AGENCY NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1649689274 . This is a "HEALTH POINT HEMPSTEAD - FACILITY NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3410037-01 . This is a "TPI HEALTH POINT HEMPSTEAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: L7280 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1635211001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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