Provider Demographics
NPI:1235286535
Name:RAVI MEDI
Entity Type:Organization
Organization Name:RAVI MEDI
Other - Org Name:RAVI MEDI
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADU
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-333-1333
Mailing Address - Street 1:2626 JOHN BEN SHEPPERD PKWY
Mailing Address - Street 2:C-129
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1958
Mailing Address - Country:US
Mailing Address - Phone:432-333-1333
Mailing Address - Fax:432-333-1335
Practice Address - Street 1:2626 JOHN BEN SHEPPERD PKWY
Practice Address - Street 2:C-129
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1958
Practice Address - Country:US
Practice Address - Phone:432-333-1333
Practice Address - Fax:432-333-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1578296-01Medicaid
00498UMedicare PIN