Provider Demographics
NPI:1821186545
Name:THOMAS SUDELA MD PA
Entity Type:Organization
Organization Name:THOMAS SUDELA MD PA
Other - Org Name:LAKE POINTE WOMEN'S CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-269-3326
Mailing Address - Street 1:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-0944
Mailing Address - Country:US
Mailing Address - Phone:214-269-3326
Mailing Address - Fax:214-269-3327
Practice Address - Street 1:2611 N BELT LINE RD STE 201
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9357
Practice Address - Country:US
Practice Address - Phone:214-269-3326
Practice Address - Fax:214-269-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203BX0001X207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093907601Medicaid
TX00G86POtherBLUE CROSS BLUE SHEILD
TX093907601Medicaid