Provider Demographics
NPI:1295946259
Name:PERMIAN GASTROENTEROLOGY ASSOCIATES LLP
Entity type:Organization
Organization Name:PERMIAN GASTROENTEROLOGY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVIKUMAR
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:VEMURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-333-3433
Mailing Address - Street 1:315 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5133
Mailing Address - Country:US
Mailing Address - Phone:432-333-3433
Mailing Address - Fax:432-333-3450
Practice Address - Street 1:315 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5133
Practice Address - Country:US
Practice Address - Phone:432-333-3433
Practice Address - Fax:432-333-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00505KMedicare PIN