=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023338464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SATISH NAYAK, M.D., P.A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2010
-----------------------------------------------------
Last Update Date | 09/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 706 HOSPITAL DR
-----------------------------------------------------
City | ANDREWS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79714-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-464-2383
-----------------------------------------------------
Fax | 432-464-2519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 706 HOSPITAL DR PO BOX 1649
-----------------------------------------------------
City | ANDREWS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79714-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-523-3001
-----------------------------------------------------
Fax | 432-464-2519
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SATISH NAYAK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 432-524-2385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | L5484
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------