| Gastrodoxs Pllc | |
|
10425 Huffmeister Rd Ste 280 Houston TX 77065-3430 | |
| (832) 632-4070 | |
| (832) 688-9496 |
| Full Name | Gastrodoxs Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10425 Huffmeister Rd Ste 280, Houston, Texas |
| Authorized Official Name and Position | Bharat Pothuri (OWNER) |
| Authorized Official Contact | 8326324070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastrodoxs Pllc 10425 Huffmeister Rd Ste 280 Houston TX 77065-3430 Ph: (832) 632-4070 | Gastrodoxs Pllc 10425 Huffmeister Rd Ste 280 Houston TX 77065-3430 Ph: (832) 632-4070 |
| NPI Number | 1811160773 |
|---|---|
| Provider Enumeration Date | 04/10/2008 |
| Last Update Date | 02/18/2022 |
| Medicare PECOS PAC ID | 5294902367 |
|---|---|
| Medicare Enrollment ID | O20120113000318 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811160773 | NPI | - | NPPES |
| 290541601 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Bharat Pothuri |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1023187614 PECOS PAC ID: 5496726499 Enrollment ID: I20040803001557 |
| Provider Name | Hua Su |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912254830 PECOS PAC ID: 9234370180 Enrollment ID: I20130719000085 |
| Provider Name | Tracy Lynn Delossantos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710691043 PECOS PAC ID: 3577929702 Enrollment ID: I20230515000563 |
| Provider Name | Raysha Monel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154102838 PECOS PAC ID: 4183063985 Enrollment ID: I20240412001503 |
| Provider Name | Michelle Wo |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1295575322 PECOS PAC ID: 2365985629 Enrollment ID: I20240614003983 |
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