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General NPI Number Information
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NPI Number | 1174654750
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Entity Type | Organization
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Legal Business Name | PRESTIGE MEDICAL P A
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 3945 COUNTY ROAD 58
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City | MANVEL
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State | TX
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Zip | 77578-2903
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Country | US
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Telephone | 281-412-6606
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Fax | 281-489-0233
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Provider Business Mailing Address
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Address Line | 3945 COUNTY ROAD 58
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City | MANVEL
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State | TX
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Zip | 77578-2903
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Country | US
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Telephone | 281-412-6606
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Fax | 281-489-0233
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. JEEVAN R SANTHA
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Credential |
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Telephone | 281-923-4112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | L7625
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License Number State | TX
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