Basic Information
| Provider Information | |||||||||
| NPI: | 1205847944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUNGTA | ||||||||
| FirstName: | MANISH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775894011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814806264 | ||||||||
| FaxNumber: | 2814804046 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775894011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814806264 | ||||||||
| FaxNumber: | 2814804046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | L4686 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 7518588 | 01 | TX | AETNA PROVIDER NUMBER | OTHER | 10016744 | 01 | TX | AMERIGROUP | OTHER | 8K6291 | 01 | TX | BCBS PROVIDER NUMBER | OTHER | 167491301 | 05 | TX | MEDICAID | 23266 | 01 | TX | MHHNP | OTHER |