Basic Information
| Provider Information | |||||||||
| NPI: | 1194049874 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNGA | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 MIDWESTERN PKWY E | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763022302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9402537160 | ||||||||
| FaxNumber: | 8334605681 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 MIDWESTERN PKWY E | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763022302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9402537160 | ||||||||
| FaxNumber: | 8334605681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2010 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Q3244 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | Q3244 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8FA827 | 01 | TX | BCBS | OTHER | P01528605 | 01 | TX | RR MEDICARE | OTHER | 349617601 | 05 | TX | MEDICAID |