Provider Demographics
NPI:1922563410
Name:VIRTX LLC
Entity Type:Organization
Organization Name:VIRTX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURROGATE
Authorized Official - Prefix:
Authorized Official - First Name:UMAMAHESWARI
Authorized Official - Middle Name:CHETHANA
Authorized Official - Last Name:MUKKAMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-469-9852
Mailing Address - Street 1:13284 BIGELOW LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0782
Mailing Address - Country:US
Mailing Address - Phone:305-469-9852
Mailing Address - Fax:
Practice Address - Street 1:13284 BIGELOW LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0782
Practice Address - Country:US
Practice Address - Phone:305-469-9852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty