MEDICARE: GARNEPUDI V PRASAD MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	G4194	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	25-00601	OTHER	TX	EVERCARE
3	0038RB	OTHER	TX	BCBS GROUP
4	4516368	OTHER	TX	BRAVO HEALTH

General Provider Information

NPI Number	:	1134366263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARNEPUDI V PRASAD MD PA

Provider Business Mailing Address
First Line	:	110 E CROCKETT ST
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4044
Country	:	US
Telephone Number	:	281-592-1515
Fax Number	:	281-592-3807

Provider Business Practice Location Address
First Line	:	110 E CROCKETT ST
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4044
Country	:	US
Telephone Number	:	281-592-1515
Fax Number	:	281-592-3807

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	IMELDA A THOMAS
Credential	:
Telephone Number	:	281-587-1141

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	03/11/2009

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