Provider Demographics
NPI:1073828927
Name:PUNJAB POWER CORP
Entity Type:Organization
Organization Name:PUNJAB POWER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SUNITA
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:NAGI
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:214-673-5484
Mailing Address - Street 1:PO BOX 630823
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-0136
Mailing Address - Country:US
Mailing Address - Phone:214-673-5484
Mailing Address - Fax:
Practice Address - Street 1:3109 6TH AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-3800
Practice Address - Country:US
Practice Address - Phone:682-312-7339
Practice Address - Fax:817-288-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220557701Medicaid
TX217769301Medicaid
TX217769302Medicaid
TXTXB120729Medicare PIN
TXTXB112824Medicare PIN
TXTXB112823Medicare PIN