Provider Demographics
NPI:1356713556
Name:GUNTER MEDICAL CENTER, PLLC
Entity type:Organization
Organization Name:GUNTER MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-769-7246
Mailing Address - Street 1:7504 SAN JACINTO PL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3233
Mailing Address - Country:US
Mailing Address - Phone:972-769-7246
Mailing Address - Fax:972-769-8811
Practice Address - Street 1:610 N 8TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GUNTER
Practice Address - State:TX
Practice Address - Zip Code:75058-3586
Practice Address - Country:US
Practice Address - Phone:972-769-7246
Practice Address - Fax:972-769-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207Q00000X, 207R00000X, 208D00000X, 208VP0014X
TXM17892081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX476611Medicare PIN
TX8F1398Medicare PIN