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General NPI Number Information
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NPI Number | 1194017145
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Entity Type | Organization
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Legal Business Name | PRECHA SUVUNRUNGSI, M.D. PA
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 2109 S CLEAR CREEK RD
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City | KILLEEN
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State | TX
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Zip | 76549-4110
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Country | US
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Telephone | 254-526-6604
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 S CLEAR CREEK RD
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City | KILLEEN
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State | TX
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Zip | 76549-4110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PRECHA SUVUNRUNGSI
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Credential | M.D.
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Telephone | 254-526-6604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | E0159
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License Number State | TX
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