Provider Demographics
NPI:1114012283
Name:SURESH PRASAD MD PA
Entity Type:Organization
Organization Name:SURESH PRASAD MD PA
Other - Org Name:PERMIAN INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-332-3400
Mailing Address - Street 1:PO BOX 4147
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760
Mailing Address - Country:US
Mailing Address - Phone:432-332-3400
Mailing Address - Fax:432-332-6500
Practice Address - Street 1:601 E 2ND SUITE A
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-332-3400
Practice Address - Fax:432-332-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0078LWOtherBLUE CROSS BLUE SHIELD
00537WMedicare PIN