Provider Demographics
NPI:1043411531
Name:SURESH N. GADASALLI,M.D.,P.A.
Entity Type:Organization
Organization Name:SURESH N. GADASALLI,M.D.,P.A.
Other - Org Name:UNIVERSITY PROMPT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SOWJANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-580-5891
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-0362
Mailing Address - Country:US
Mailing Address - Phone:432-580-5891
Mailing Address - Fax:
Practice Address - Street 1:2651 KERMIT HWY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-2542
Practice Address - Country:US
Practice Address - Phone:432-333-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALTHY HEART CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty