MEDICARE: MR. SUNDERRAM V SATYAVADA CRT, RCP

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	332BX2000X	Oxygen Equipment & Supplies (DME)	57471	TX

General Provider Information

NPI Number	:	1669774634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SUNDERRAM V SATYAVADA CRT, RCP

Provider Business Mailing Address
First Line	:	3402 N BIG SPRING ST
Second Line	:	SUITE A
City	:	MIDLAND
State	:	TX
Zip	:	79705-5503
Country	:	US
Telephone Number	:	432-683-1199
Fax Number	:	432-683-1105

Provider Business Practice Location Address
First Line	:	3402 N BIG SPRING ST
Second Line	:	SUITE A
City	:	MIDLAND
State	:	TX
Zip	:	79705-5503
Country	:	US
Telephone Number	:	432-683-1199
Fax Number	:	432-683-1105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	11/24/2010

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