Provider Demographics
NPI:1164710570
Name:PREMA L. VINDHYA, M.D., P. A.
Entity Type:Organization
Organization Name:PREMA L. VINDHYA, M.D., P. A.
Other - Org Name:PREMALATHA VINDHYA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PREMALATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VINDHYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-333-1901
Mailing Address - Street 1:2479 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4232
Mailing Address - Country:US
Mailing Address - Phone:432-333-1901
Mailing Address - Fax:432-520-5914
Practice Address - Street 1:2479 E 11TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4232
Practice Address - Country:US
Practice Address - Phone:432-333-1901
Practice Address - Fax:432-520-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7739174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1952355166OtherTYPE I NPI