1831115088 NPI number — VENKATESH MOVVA MD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831115088 NPI number — VENKATESH MOVVA MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VENKATESH MOVVA MD PLLC
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:
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:
1831115088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74121-1568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-502-4000
Provider Business Mailing Address Fax Number:
918-502-4001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6565 S YALE AVE
Provider Second Line Business Practice Location Address:
#212
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-502-4000
Provider Business Practice Location Address Fax Number:
918-502-4001
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOVVA
Authorized Official First Name:
VENKATESH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
918-502-4000

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  20519 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7999176 . This is a "AETNA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 103863500 . This is a "STATE OF OK WC" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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