Healthcare Provider Details

I. General information

NPI: 1194017145
Provider Name (Legal Business Name): PRECHA SUVUNRUNGSI, M.D. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 S CLEAR CREEK RD
KILLEEN TX
76549-4110
US

IV. Provider business mailing address

2109 S CLEAR CREEK RD
KILLEEN TX
76549-4110
US

V. Phone/Fax

Practice location:
  • Phone: 254-526-6604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberE0159
License Number StateTX

VIII. Authorized Official

Name: DR. PRECHA SUVUNRUNGSI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 254-526-6604