Provider Demographics
NPI:1356452668
Name:MIDLAND SURGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:MIDLAND SURGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEPA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSUNURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-697-1061
Mailing Address - Street 1:2405 W MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6800
Mailing Address - Country:US
Mailing Address - Phone:432-697-1061
Mailing Address - Fax:432-697-7089
Practice Address - Street 1:2405 W MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6800
Practice Address - Country:US
Practice Address - Phone:432-697-1061
Practice Address - Fax:432-697-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCN7004OtherMEDICARE RAILROAD GROUP
TX0087CGOtherBLUE CROSS GROUP NUMBER
TXZ000042F2Medicaid
TX00042FOtherMEDICARE GROUP PTAN
NMS0756Medicaid