Organization
PRUDENICO AVENDANIO MDPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRUDENCIO C AVENDANIO MD (PRESIDENT)
(903) 342-0921
Entity
Organization
Contact information
Practice address
719 W COKE RD, WINNSBORO, TX 75494-3011
(903) 342-5227
Mailing address
PO BOX 8337, AMARILLO, TX 79114-8337
(806) 355-6593
(806) 352-8774
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
F4745
TX
2085R0204X
Vascular & Interventional Radiology Physician
F4745
TX
2085U0001X
Diagnostic Ultrasound Physician
F4745
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00JP90
BLUE CROSS
TX
01
—
110999
SUPERIOR
—
Enumeration date
05/23/2006
Last updated
04/20/2008
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