Organization
GUADALUPE VALLEY SURGICAL ASSOCIATES PA
Active
Other names
Permian Basin Surgical Assoc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN WADE FATH MD (OWNER/MD)
(432) 333-8400
Entity
Organization
Contact information
Practice address
420 E 6TH ST STE 104, ODESSA, TX 79761-4537
(432) 333-8400
(432) 333-8401
Mailing address
420 E 6TH ST STE 104, ODESSA, TX 79761-4537
(432) 333-8400
(432) 333-8401
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
K8144
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040430302
—
TX
Enumeration date
08/21/2009
Last updated
08/26/2011
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