Provider Demographics
NPI:1003904335
Name:TEXOMA ARTHRITIS CLINIC, P.A.
Entity Type:Organization
Organization Name:TEXOMA ARTHRITIS CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUREKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANGASANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-547-9700
Mailing Address - Street 1:1445 HERITAGE DR
Mailing Address - Street 2:STE A
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3394
Mailing Address - Country:US
Mailing Address - Phone:972-547-9700
Mailing Address - Fax:972-547-1110
Practice Address - Street 1:1445 HERITAGE DR
Practice Address - Street 2:STE A
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3394
Practice Address - Country:US
Practice Address - Phone:972-547-9700
Practice Address - Fax:972-547-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6205090001Medicare NSC