DR. VASUDEVA M BOMMANNA (NPI# 1477594836) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477594836 |
| Entity Type | Individual |
| Full Name | DR. VASUDEVA M BOMMANNA |
| Credential | MD |
| Practice Address |
607 Russell Blvd Suite ' B' Nacogdoches TX 75965-1247 |
| Practice Telephone | 9365597750 |
| Practice Fax Number | 9365597807 |
| Mailing Telephone | 9365597750 |
| Mailing Fax Number | 9365597807 |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2007-07-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207K00000X | Allergy & Immunology | K 3685 | TX | Allopathic & Osteopathic Physicians |
| Y | 207KA0200X |
Allergy & Immunology Specialization: Allergy |
K 3685 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BLUE CROSS # | 0020CF | 01 |
| TX | MEDICARE # FOR WEBSTER | 612574 | 01 |
| Street Address |
607 RUSSELL BLVD SUITE ' B' |
| City | NACOGDOCHES |
| State | TX |
| Zip Code | 75965-1247 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346246964 | Kavita S Vyas | Family Medicine | 607 Russell Blvd, A, Nacogdoches, TX 75965-1247 | 2005-06-28 |
| 1841248630 | Nacogdoches Medical Clinic Pllc | Internal Medicine | 607 Russell Blvd, A, Nacogdoches, TX 75965-1247 | 2006-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649839135 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 3824 N University Drive, Suite 103, Nacogdoches, TX 75965 | 2019-06-10 |
| 1518520493 | Billy Jobe | Pharmacist | 917 East Austin, Nacogdoches, TX 75965 | 2019-04-17 |
| 1295217610 | Sarah Ponder | Registered Nurse | 625 Woodway Lane, Nacogdoches, TX 75965 | 2018-09-01 |
| 1083107684 | Aakash Deep Gupta | Dentist | 4610 North St Ste 101b, Nacogdoches, TX 75965 | 2018-06-08 |
| 1679097455 | Emily Morris Taravella | Counselor | 3524 Ne Stallings Drive, Nacogdoches, TX 75965 | 2017-08-02 |
| 1457809949 | Kassey Osborn | Nurse Practitioner | 4920 Ne Stallings Dr., Nacogdoches Medical Center, Nacogdoches, TX 75965 | 2016-09-14 |
| 1629426747 | Lisa Greathouse | Technician, Other | 500 Chincapin, Westville, OK 75965 | 2016-05-31 |
| 1457741704 | Nuch of Texas | Pediatrics | 1305 North Street, Nacogdoches, TX 75965 | 2015-01-26 |
| 1730506031 | Benjamin Patrick Thompson | Obstetrics & Gynecology | 4800 Ne Stallings Dr Ste 106, Nacogdoches, TX 75965 | 2014-03-25 |
| 1255761813 | Kallie Krawietz | Counselor | 2214 N Pecan Street, Nacogdoches, TX 75965 | 2013-11-19 |
| Find all providers in zip 75965 | ||||
| Taxonomy Code | 207KA0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| Specialization | Allergy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689148470 | Stephanie Kathrynann Angell | Allergy & Immunology | 415 Downing St, Belton, TX 76513-2049 | 2019-01-15 |
| 1144792615 | Integrated Wellness Clinics Pllc | Allergy & Immunology | 3308 Preston Rd Ste 350-307, Plano, TX 75093-7453 | 2018-12-21 |
| 1073963526 | San Antonio Allergenic and Wellness LLC | Allergy & Immunology | 9023 Huebner Rd, Ste 105, San Antonio, TX 78240-2071 | 2016-06-15 |
| 1629428164 | South Austin Allergy and Wellness LLC | Allergy & Immunology | 11530 Manchaca Rd, Unit 2-a, Austin, TX 78748-2712 | 2016-06-15 |
| 1962896340 | Southwest Hcp Access Pa | Allergy & Immunology | 211 Bartlett Dr, Suite 108, El Paso, TX 79912 | 2015-03-24 |
| 1417377839 | Sasha Ahangama Alvarado | Allergy & Immunology | 623 W Fm 544 Ste 104, Murphy, TX 75094-4587 | 2014-04-24 |
| 1972949048 | Amanda Lewis | Allergy & Immunology | 10607 Quaker Ave Unit 102, Lubbock, TX 79424-8465 | 2013-05-16 |
| 1912343419 | Zachary Wade Marshall | Allergy & Immunology | 205 N Oak St Unit B, Roanoke, TX 76262-7001 | 2013-05-12 |
| 1902241292 | Tr Diagnostic Radiology Management Inc | Allergy & Immunology | 3620 N Josey Ln Ste 116, Carrollton, TX 75007-3151 | 2013-05-01 |
| 1831533157 | U S Allergy Labs, LLC | Allergy & Immunology | 2008 N Navarro St, Ste B, Victoria, TX 77901-4824 | 2013-04-18 |
| Find all providers with the same taxonomy | ||||
| City | NACOGDOCHES |
| Zip Code | 75965 |
Please comment or provide details below to improve the information on DR. VASUDEVA M BOMMANNA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.