Provider Demographics
NPI:1679717763
Name:2920 MEDICAL MANAGMENT GROUP, LLC
Entity type:Organization
Organization Name:2920 MEDICAL MANAGMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:SUSHMA
Authorized Official - Middle Name:VEERA
Authorized Official - Last Name:GORRELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-257-0404
Mailing Address - Street 1:6225 FM 2920
Mailing Address - Street 2:STE 100
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379
Mailing Address - Country:US
Mailing Address - Phone:281-257-0404
Mailing Address - Fax:281-605-4563
Practice Address - Street 1:6225 FM 2920
Practice Address - Street 2:STE 150
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:281-257-0404
Practice Address - Fax:281-605-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty