Organization Active NPI

Guadalupe Valley Surgical Associates PA

Doing business as Permian Basin Surgical Assoc

  • Surgery Physician
  • Odessa, TX
National Provider Identifier
1114159357
Registry record updated Aug 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
K8144 Issued in TX
Legal business name
GUADALUPE VALLEY SURGICAL ASSOCIATES PA
Doing business as
Permian Basin Surgical Assoc
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
Last updated
Aug 26, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2011

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

Authorized official

Name
Dr. Steven Wade Fath, MDNPI 1982661542
Title
Owner/MD
Phone
(432) 333-8400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X K8144 TX Primary

Addresses

Primary practice location

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

Mailing address

420 E 6TH St Ste 104
Odessa, TX 79761-4537
Phone (432) 333-8400

Other names 1

  • Permian Basin Surgical Assoc Doing business as

National Provider Directory

National Provider Directory

Locations

420 E 6th St
Ste 104
Odessa, TX 79761
Phone (432) 333-8400

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Permian Basin Surgical Assoc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Odessa, TX

Sources for this page

  • 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.