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General NPI Number Information
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NPI Number | 1275178832
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Entity Type | Organization
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Legal Business Name | SUSHRUTA SURGICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 420 E 6TH ST STE 102
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City | ODESSA
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State | TX
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Zip | 79761-4537
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Country | US
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Telephone | 432-582-8589
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E 6TH ST STE 102
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City | ODESSA
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State | TX
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Zip | 79761-4537
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Country | US
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Telephone | 432-888-9001
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | SUBHASH NAGALLA
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Credential | MD
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Telephone | 432-888-9001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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