Provider Demographics
NPI:1306111448
Name:SOUTHWEST GASTROENTEROLOGY ASSOCIATES PLLC
Entity type:Organization
Organization Name:SOUTHWEST GASTROENTEROLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:R
Authorized Official - Last Name:KURELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-631-0481
Mailing Address - Street 1:525 SW 80TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139
Mailing Address - Country:US
Mailing Address - Phone:405-631-0481
Mailing Address - Fax:405-631-9025
Practice Address - Street 1:525 SW 80TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139
Practice Address - Country:US
Practice Address - Phone:405-631-0481
Practice Address - Fax:405-631-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22226207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty