Provider Demographics
NPI:1487836672
Name:VITTAL T PAI, M.D., P.A.
Entity Type:Organization
Organization Name:VITTAL T PAI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SARABIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-522-7977
Mailing Address - Street 1:2415 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5049
Mailing Address - Country:US
Mailing Address - Phone:575-522-7977
Mailing Address - Fax:575-522-0930
Practice Address - Street 1:2415 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5049
Practice Address - Country:US
Practice Address - Phone:575-522-7977
Practice Address - Fax:575-522-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM74-218207KA0200X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01347Medicaid
NMNM002086OtherBLUE CROSS BLUE SHIELD
NMNM002086OtherBLUE CROSS BLUE SHIELD