Provider Demographics
NPI:1679901847
Name:MDSA TEXAS INC.
Entity type:Organization
Organization Name:MDSA TEXAS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUDHOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-655-9294
Mailing Address - Street 1:PO BOX 630066
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-0100
Mailing Address - Country:US
Mailing Address - Phone:972-655-9294
Mailing Address - Fax:972-655-9294
Practice Address - Street 1:2705 HOSPITAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-0928
Practice Address - Country:US
Practice Address - Phone:972-314-9900
Practice Address - Fax:972-314-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty