NPIMap

Organization Active NPI

Avanti-Ayush, LLC

Doing business as The Vintage

  • Case Management Agency
  • Fort Stockton, TX
National Provider Identifier
1992252431
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
AVANTI-AYUSH, LLC
Doing business as
The Vintage
Practice address
237 W 21St St
Fort Stockton, TX 79735-2536
Phone
(432) 290-2510
NPI assigned
Sep 1, 2016
Last updated
Sep 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Authorized official

Name
Subodh Mallik, M.D.
Title
Owner
Phone
(432) 290-2510

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

237 W 21St St
Fort Stockton, TX 79735-2536

Mailing address

1609 Westwind Dr.
Fort Stockton, TX 79735-2515
Phone (432) 290-2510

Other names 1

  • The Vintage Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Avanti Ayush3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1992252431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 WESTWIND DR.",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797352515",
            "telephone_number": "432-290-2510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 W 21ST ST",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797352536",
            "telephone_number": "432-290-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTI-AYUSH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "MALLIK",
        "authorized_official_first_name": "SUBODH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "432-290-2510",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Vintage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Stockton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.