Provider Demographics
NPI:1942308200
Name:SUNDERRAM V SATYAVADA
Entity Type:Organization
Organization Name:SUNDERRAM V SATYAVADA
Other - Org Name:SUNDERRAM V SATYAVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERIPIST/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNDERRAM
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:SATYAVADA
Authorized Official - Suffix:
Authorized Official - Credentials:CRT/ RCP
Authorized Official - Phone:432-683-1199
Mailing Address - Street 1:3402 N BIG SPRING ST STE A
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-5503
Mailing Address - Country:US
Mailing Address - Phone:432-683-1199
Mailing Address - Fax:432-683-1105
Practice Address - Street 1:3402 N BIG SPRING ST
Practice Address - Street 2:STE A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-5503
Practice Address - Country:US
Practice Address - Phone:432-683-1199
Practice Address - Fax:432-683-1105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNDERRAM V SATYAVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0058466332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1139100001Medicare NSC