1144294711 NPI number — SRIDHAR NARRA MD

Table of content: SRIDHAR NARRA MD (NPI 1144294711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144294711 NPI number — SRIDHAR NARRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NARRA
Provider First Name:
SRIDHAR
Provider Middle Name:
Provider Name Prefix Text:
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:
1144294711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3708 JEFFERSON ST
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-6206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-459-6503
Provider Business Mailing Address Fax Number:
512-454-7453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3708 JEFFERSON ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78731-6206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-459-6503
Provider Business Practice Location Address Fax Number:
512-454-7453
Provider Enumeration Date:
02/13/2006

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: 207R00000X , with the licence number:  4301074999 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: N1401 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 443744010 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5237621 . This is a "LEGACY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5315009871 . This is a "PHARMACY LIC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: TXB155615 . This is a "WELLMED NETWORKS INC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 104437440 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: TXB155615 . This is a "WELLMED NETWORKS INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: TXB150302 . This is a "WELLMED MEDICAL GROUP PA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com