Provider Demographics
NPI:1144570599
Name:GUMMADI & DESAI LLC
Entity Type:Organization
Organization Name:GUMMADI & DESAI LLC
Other - Org Name:EDINBURG ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-668-1111
Mailing Address - Street 1:2717 MICHAEL ANGELO STE 302
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-1409
Mailing Address - Country:US
Mailing Address - Phone:956-668-1111
Mailing Address - Fax:
Practice Address - Street 1:2717 MICHAEL ANGELO STE 302
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1409
Practice Address - Country:US
Practice Address - Phone:956-668-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2044637OtherCLIA