Prudenico Avendanio Mdpa

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

F4745 Issued in TX

Legal business name

PRUDENICO AVENDANIO MDPA

Practice address

719 W Coke Rd
Winnsboro, TX 75494-3011

Phone

(903) 342-5227

NPI assigned

May 23, 2006

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Prudencio C Avendanio, MD

Title

President

Phone

(903) 342-0921

Specialties & licenses 3

Addresses

Other identifiers 2

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1609821453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8337",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791148337",
            "telephone_number": "806-355-6593",
            "fax_number": "806-352-8774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 W COKE RD",
            "city": "WINNSBORO",
            "state": "TX",
            "postal_code": "754943011",
            "telephone_number": "903-342-5227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUDENICO AVENDANIO MDPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "AVENDANIO",
        "authorized_official_first_name": "PRUDENCIO",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-342-0921",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "F4745",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "TX",
            "license": "F4745",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "TX",
            "license": "F4745",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPERIOR",
            "identifier": "110999",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00JP90",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Peterson, LPC, NCC, DCC
• Jared B Petty, DO
• Michael Wayne Phillips, CRNA
• Misty Ann Pierce, RN
• Suzanne Pope, COTA
• Juan Francisco Quintana, CRNA
• Quitman Hospital LLC
• Abbey Elizabeth Redding
• Donna Marie Regino, FNP-BC
• Gregg Howard Risner, DC

• Diagnostic Radiology Physician in Winnsboro, TX
• Providers in Winnsboro, TX by specialty
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.