Provider Demographics
NPI:1922297670
Name:PAMELA S. CUNNINGHAM, M.D., P.A.
Entity Type:Organization
Organization Name:PAMELA S. CUNNINGHAM, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-331-1234
Mailing Address - Street 1:PO BOX 1808
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-1808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N GRANT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4503
Practice Address - Country:US
Practice Address - Phone:432-331-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0387208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174107601Medicaid
TXY37310Medicare UPIN
TX174107601Medicaid