1205821170 NPI number — DR. PURUSHOTTAM M REDDY MD

Table of content: DR. PURUSHOTTAM M REDDY MD (NPI 1205821170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205821170 NPI number — DR. PURUSHOTTAM M REDDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
PURUSHOTTAM
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205821170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14134 NEPHRONE LANE
Provider Second Line Business Mailing Address:
RENAL HYPERTENSION CENTER
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-863-5418
Provider Business Mailing Address Fax Number:
727-869-8626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14134 NEPHRON LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-863-5418
Provider Business Practice Location Address Fax Number:
727-869-8626
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  ME005664 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 593068073 . This is a "HUMANA MILITARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 593068073 . This is a "PCHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110069456 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1042 . This is a "OPTIMUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2217334 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 052954100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 210962 . This is a "AV-MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 593068073 . This is a "SOUTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004106456 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01245 . This is a "UNIVERSAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 593068073 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 933673 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09594 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10501601 . This is a "CITRUS HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2504281 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 933673 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PRO127 . This is a "QUALITY DELTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 024625000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com