Provider Demographics
NPI:1821322595
Name:PRASANNA K.N.KUMAR M.D. F.R.C.S. P.A.
Entity Type:Organization
Organization Name:PRASANNA K.N.KUMAR M.D. F.R.C.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-589-2517
Mailing Address - Street 1:3813 DIAMOND LOCH W
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8729
Mailing Address - Country:US
Mailing Address - Phone:817-589-2517
Mailing Address - Fax:817-284-7021
Practice Address - Street 1:3813 DIAMOND LOCH W
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76180-8729
Practice Address - Country:US
Practice Address - Phone:817-589-2517
Practice Address - Fax:817-284-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6274282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD66768Medicare UPIN