Provider Demographics
NPI: | 1295736973 |
---|---|
Name: | PPG HEALTH, PA |
Entity type: | Organization |
Organization Name: | PPG HEALTH, PA |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PONNIAH |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | SANKARAPANDIAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 817-877-5858 |
Mailing Address - Street 1: | 1000 W CANNON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT WORTH |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76104-3029 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 817-877-5858 |
Mailing Address - Fax: | 817-335-4418 |
Practice Address - Street 1: | 1000 W CANNON ST |
Practice Address - Street 2: | |
Practice Address - City: | FORT WORTH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76104-3029 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-877-5858 |
Practice Address - Fax: | 817-335-4418 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-08-03 |
Last Update Date: | 2025-04-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RT0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 00QQ28 | Other | BLUE CROSS |
TX | 084560402 | Medicaid | |
TX | 084560401 | Medicaid |