Provider Demographics
NPI:1831115088
Name:VENKATESH MOVVA MD PLLC
Entity Type:Organization
Organization Name:VENKATESH MOVVA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VENKATESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOVVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-502-4000
Mailing Address - Street 1:PO BOX 21568
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1568
Mailing Address - Country:US
Mailing Address - Phone:918-502-4000
Mailing Address - Fax:918-502-4001
Practice Address - Street 1:6565 S YALE AVE
Practice Address - Street 2:#212
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-502-4000
Practice Address - Fax:918-502-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20519208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7999176OtherAETNA
OK103863500OtherSTATE OF OK WC
OK103863500OtherSTATE OF OK WC