Provider Demographics
NPI:1649858556
Name:SPRITE HEALTH MSO, INC.
Entity type:Organization
Organization Name:SPRITE HEALTH MSO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-639-3206
Mailing Address - Street 1:1804 SHADY GROVE CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-8236
Mailing Address - Country:US
Mailing Address - Phone:512-639-3206
Mailing Address - Fax:
Practice Address - Street 1:5000 RIVERSIDE DR STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4314
Practice Address - Country:US
Practice Address - Phone:512-639-3206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty