Provider Demographics
NPI:1174654750
Name:PRESTIGE MEDICAL P A
Entity Type:Organization
Organization Name:PRESTIGE MEDICAL P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEEVAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANTHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-923-4112
Mailing Address - Street 1:3945 COUNTY ROAD 58
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-2903
Mailing Address - Country:US
Mailing Address - Phone:281-412-6606
Mailing Address - Fax:281-489-0233
Practice Address - Street 1:3945 COUNTY ROAD 58
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-2903
Practice Address - Country:US
Practice Address - Phone:281-412-6606
Practice Address - Fax:281-489-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7625261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care