1700321890 NPI number — SVAS MEDICAL GROUP WHOLESALE DIST LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700321890 NPI number — SVAS MEDICAL GROUP WHOLESALE DIST LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SVAS MEDICAL GROUP WHOLESALE DIST LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GENERATIONS MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700321890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19780 SOUTHWEST FWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-6594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-232-5559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19780 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-6594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-232-5559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CHILAKAPATI
Authorized Official First Name:
VISH
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
281-232-5559

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1001034 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 1001034 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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