Provider Demographics
NPI:1194017145
Name:PRECHA SUVUNRUNGSI, M.D. PA
Entity Type:Organization
Organization Name:PRECHA SUVUNRUNGSI, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRECHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUVUNRUNGSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-526-6604
Mailing Address - Street 1:2109 S CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2109 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-526-6604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0159305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110432502Medicaid
TXB26792Medicare UPIN
TX110432502Medicaid