Provider Demographics
NPI:1780757088
Name:GUNDLAPALLI'S ADVANCED PAIN CENTER
Entity type:Organization
Organization Name:GUNDLAPALLI'S ADVANCED PAIN CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAI
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUNDLAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:432-333-5200
Mailing Address - Street 1:801 N JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4002
Mailing Address - Country:US
Mailing Address - Phone:432-333-5200
Mailing Address - Fax:432-333-1800
Practice Address - Street 1:801 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4002
Practice Address - Country:US
Practice Address - Phone:432-333-5200
Practice Address - Fax:432-333-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty