1972941318 NPI number — SRINIVAS RAO MD PA

Table of content: (NPI 1972941318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972941318 NPI number — SRINIVAS RAO MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SRINIVAS RAO MD PA
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:
TEXAS VEIN AND WELLNESS INSTITUTE
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:
1972941318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11221 KATY FWY
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77079-2105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-888-1464
Provider Business Mailing Address Fax Number:
713-640-5938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11221 KATY FWY
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77079-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-888-1464
Provider Business Practice Location Address Fax Number:
713-640-5938
Provider Enumeration Date:
06/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RAO
Authorized Official First Name:
SRINIVAS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-240-4913

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  H7644 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com