1821186545 NPI number — THOMAS S SUDELA MD PA

Table of content: (NPI 1821186545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821186545 NPI number — THOMAS S SUDELA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS S SUDELA MD PA
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:
LAKE POINTE WOMEN'S CENTRE
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:
1821186545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 944
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROWLETT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75030-0944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-269-3326
Provider Business Mailing Address Fax Number:
214-269-3327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2504 RIDGE RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKWALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75087-2571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-722-0404
Provider Business Practice Location Address Fax Number:
972-722-7082
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
JANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
214-269-3326

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  203BX0001X , 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)

  • Identifier: 00G86P . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 093907601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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