Guadalupe Valley Surgical Associates PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

K8144 Issued in TX

Legal business name

GUADALUPE VALLEY SURGICAL ASSOCIATES PA

Practice address

420 E 6TH St Ste 104
Odessa, TX 79761-4537

Phone

(432) 333-8400

Fax

(432) 333-8401

NPI assigned

Aug 21, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Steven Wade Fath, MD

Title

Owner/MD

Phone

(432) 333-8400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Permian Basin Surgical Assoc Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314316800000",
    "number": "1114159357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E 6TH ST STE 104",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797614537",
            "telephone_number": "432-333-8400",
            "fax_number": "432-333-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E 6TH ST STE 104",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797614537",
            "telephone_number": "432-333-8400",
            "fax_number": "432-333-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUADALUPE VALLEY SURGICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-21",
        "last_updated": "2011-08-26",
        "status": "A",
        "authorized_official_last_name": "FATH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "432-333-8400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "TX",
            "license": "K8144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040430302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Permian Basin Surgical Assoc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brooks Ross Greger II, CRNA
• Gregory J Atwood DDS LTD
• Brian W Griffin, NP
• Bobbie J Grimes
• Nicole Harris Grimes, APRN, FNP-C
• Vamsi Krishna Gudapati
• Padmini Gudibanda
• Keren Guiab, MD
• Iliana A Guillen, COTA
• Joann Mercedes Georges Guillory, ARNP

• All providers in Odessa, TX
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.