Provider Demographics
NPI:1659956308
Name:THEERAPOL PRASERTSUNTARASAI MD PA
Entity Type:Organization
Organization Name:THEERAPOL PRASERTSUNTARASAI MD PA
Other - Org Name:WEST TEXAS ARTHRITIS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEERAPOL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASERTSUNTARASAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-589-1778
Mailing Address - Street 1:5609 114TH STREET
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424
Mailing Address - Country:US
Mailing Address - Phone:806-589-1778
Mailing Address - Fax:806-589-1779
Practice Address - Street 1:5609 114TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-6985
Practice Address - Country:US
Practice Address - Phone:806-589-1778
Practice Address - Fax:806-589-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR1108OtherLICENSE